
Glass. 
Book- 



COPYRIGHT DEPOSIT 



HEALTH 
AND THE SCHOOL 

A Round Table 

BY 

FRANCES WILLISTON BURKS 

AND 

JESSE D. BURKS 

DIRECTOR, BUREAU OF MUNICIPAL RESEARCH, PHILADELPHIA 



WITH AN INTRODUCTION BY 

FRANK M. McMURRY 

PROFESSOR OP ELEMENTARY EDUCATION 
TEACHERS COLLEGE, NEW YORK 




D. APPLETON AND COMPANY 
NEW YORK CHICAGO 



.^'^I'J'^ 



v^ ^' 



Copyright, 1913, by 
D. APPLETON AND COMPANY 



-n 



)CI.A3 512 26 






'1 

TO 

AMERICA'S MOTHERS AND TEACHERS 

GUAHDIANS OF A NATION'S STRENGTH 



INTRODUCTION 

Recent years have witnessed notable advances in our 
comprehension of the conditions governing the health of 
children. We have been astonished at the number of de- 
fects found among them; we have received new convic- 
tions in regard to provision for air and play ; and we have 
become acquainted with better methods for warding ofif 
disease. 

Nor is our attitude on this whole matter by any means 
so theoretical as it was even a few years ago. Indeed, 
the extent to which all this knowledge is finding applica- 
tion, in communities of all sorts, is striking. Herbert 
SpcLci . charge that people were generally far more in- 
terested in the health and general care of their horses, 
cattle, and hogs than in that of their children will 
hardly hold much longer. And it seems likely that good 
health will soon rank £rst, in the minds of teachers and 
parents, among the things that make up a good educa- 
tion. 

The realization of this promise will mark a revolution 
in the practice of the schools ; for, in times past, they 
have really, if not consciously, sacrificed health for the 
acquisition of knowledge. Training institutions for 
teachers have even been among the worst offenders in 
this respect. But observation is teaching us that, while 
neither knowledge nor health can be wholly neglected, 
the former is far inferior to the latter as a condition of 

vii 



viii INTRODUCTION 

success. School instruction in physiology and hygiene is 
still almost a farce, to be sure; but a better time is in 
sight. 

In consequence of the striking advances in this field, 
there is pressing need of literature that summarizes both 
the theory and practice at present accepted, and in a style 
making the facts thoroughly clear and interesting to the 
ordinary reader. 

The present volume helps to meet this need in a most 
effective way. It accomplishes three things : From widely 
scattered sources it brings together the theoretical facts 
pertaining to health, that seem well established, and that 
are most valuable ; it suggests how these facts have been 
applied, and, to some extent, shows the extent of that 
application up to the present time; and it presents all 
this matter in a surprisingly simple and attractive man- 
ner. 

While excellent judgment seems to have been shown 
in determining what should be presented, the style of 
presentation is specially worthy of attention. The 
method is conversational, the subjects of conversation 
being just such questions and objections as the thought- 
ful, really interested, but perhaps skeptical person would 
desire to ask; and these are answered in a remarkably 
direct and convincing way. 

F. M. McMuRRY. 
Teachers College, 

Columbia University, 
New York City. 



PREFACE 

The present widely aroused interest in matters of 
health has developed a great need among teachers and 
parents and public officials for practical guidance. The 
sickness and health of children are not really controlled 
by fate and the doctors, as many parents and teachers as- 
sume, but by those who regulate the daily conditions un- 
der which children live — parents, teachers and govern- 
ment officials. If these controlling powers are not thor- 
oughly informed and intelligently alert, no amount of 
national agitation and legislation will secure the health 
of children. 

It is comparatively easy for people with no technical 
training to learn a few fundamental matters concerning 
health — what normal health is, the conditions essential to 
its maintenance, the detection of many organic defects, 
the approach of acute diseases, and the effect upon indi- 
vidual children and their associates of allowing remov- 
able defects and diseases to continue. 

This book sets forth the health problems which must 
be met in every school and family, and furnishes a work- 
ing program for parents, teachers, school boards and 
boards of health. 

The material has been put in the form of conferences 
such as might take place in any town which is success- 
fully solving the problems connected with the health of 
its children. While most of the problems under discus- 
sion are focused in the school and the home, the people 



X PREFACE 

taking part in the conferences are not limited to teachers 
and parents. The health of children is a concern not ex- 
clusively of anxious parents or faithful teachers, neither 
of which groups has yet been very successful in securing 
it. Healthy children are vitally needed by the whole 
community which has to exert its highest intelligence and 
power to produce them. 

In the following conferences the zeal of teachers and 
the solicitude of parents are supplemented by the scien- 
tific knowledge of a physician, the experience and sym- 
pathy of a social worker, and the practical sense of a suc- 
cessful business man. 

The characters are not of course transcribed from life, 
nor is it claimed that the investigations and reforms cred- 
ited to them have as yet all taken place in a single town. 
Each one, however, has taken place in some town. Every 
statistical item reported has been secured through actual 
investigation, in various cities and states. 

The time has come for such scattered investigations 
and reforms to be included in the health program of 
every town. Many communities realize this, but are un- 
certain how to begin their novel task. It can only be 
accomplished through groups of active citizens for whom 
the conference method in this book may serve as a sug- 
gestion for procedure. 



ACKNOWLEDGMENT 

Grateful acknowledgment is made to the following 
persons for criticism and constructive suggestions in the 
preparation of this volume : 

WilHam H. Allen, Director, Bureau of Municipal 

Research, New York, Author of Civics and 

Health. 
Frederick Almy, Secretary, Charity Organization 

Society, Buffalo. 
Ellen C. Babbitt, Child Helping Department, Russell 

Sage Foundation. 
Alice C. Boughton, Superintendent of Lunches, 

Home and School League, Philadelphia. 
Martin G. Brumbaugh, Superintendent of Schools, 

Philadelphia. 
Richard C. Cabot, M. D., Assistant Professor of 

Clinical Medicine, Harvard University. 
Arthur D. Dean, Chief, Division of Vocational 

Schools, State Education Department, New York. 
James Mapes Dodge, Chairman, Link-Belt Company, 

Philadelphia. 
Samuel T. Dutton, Superintendent, Horace Mann 

School, Teachers College, New York. 
Edward C. Elliott, Director, Course for the Train- 
ing of Teachers, University of Wisconsin. 
Luther H. Gulick, M. D., Director, Department of 

Child Hygiene, Russell Sage Foundation. 



xii ACKNOWLEDGMENT 

Samuel McC. Hamill, M. D., Professor of Diseases 
of Children, Philadelphia Polyclinic Hospital and 
College for Graduates in Medicine. 

W. W. Keen, M. D., Professor Emeritus of Surgery, 
Jefferson Medical College, Philadelphia. 

Frank M. McMurry, Professor of Elementary Edu- 
cation, Teachers College, New York City. 

Rudolph R. Reeder, Superintendent, New York 
Orphanage, Hastings-on-Hudson. 

Ella Flagg Young, Superintendent of • Schools, 
Chicago. 

Acknowledgment is also due to the following, for the 
use of illustrations : 

Board of Recreation, Philadelphia; Bureau of Health, 
Philadelphia ; Bureau of Municipal Research, Philadel- 
phia; Child Hygiene Association, Philadelphia; Depart- 
ment of Health, Chicago; Home and School League, 
Philadelphia ; Horace Mann School, New York City ; 
National Cash Register Company, Dayton, Ohio; New 
York Orphanage, Hastings-on-Hudson; Playground and 
Recreation Association of America ; Review of Reviews, 
New York ; Russell Sage Foundation, New York ; Sey- 
bert Children's Village, Meadowbrook, Pa. ; Society for 
the Relief and Prevention of Tuberculosis, St. Louis ; 
State Board of Health, Virginia ; Taylor Instrument 
Companies, Rochester, New York ; The Detroit Saturday 
Night, Detroit, Michigan; World Book Company, Yon- 
kers. New York. 



CONTENTS 

PART I 

THE BREAKDOWN OF THE SCHOOL IN ITS HEALTH 
PROGRAM 

PAGE 

I. Are Education and Health Incompatible? 

Are our schools and homes producing healthy or defective 
children? — Should the schools add responsibility for 
health, and thorough training in hygiene, to their al- 
ready numerous obligations? — If the aim of education in 
school or home is to prepare adequately for the efficient 
life of which health is an indispensable factor, is not 
the home or school that does not secure the highest 
possible degree of health and vitality for its members 
a failure? ......... i 

II. Health Census of a School 

Astounding number of pupils found with removable defects, 
— adenoids, enlarged tonsils, decayed teeth, impaired 
vision, spinal curvature, anaemia, malnutrition, etc. — 
An account of these defects and the resulting func- 
tional derangements — poor assimilation, nervousness, fa- 
tigue 12 

III. Sanitary Inspection of a School Building 

Sanitary conditions described, — ventilation, heating, lighting, 
drinking and toilet arrangements, cleaning of building, 
adjustment of desks, etc. — Means of correcting faulty 
conditions. — Standards of sanitation summarized . . 29 



xiv CONTENTS 

IV. A School Child's Day 

PAGE 

A study of the daily program: number of hours of work, 
rest, exercise, and recreation desirable. — Necessary alter- 
nations of kind of work and of work and rest . . 55 

PART II 

THE OPPORTUNITY OF THE SCHOOL FOR PRO- 
MOTING HEALTH 

V. Cooperation with Parents in Securing Medical Aid 

Cooperation between school and home indispensable. — 
School and health boards in need of authority to re- 
quire necessary treatment. — General education a more 
fundamental corrective than general coercion. — Meth- 
ods by which health officers, teachers, and enlightened 
parents can enlist the cooperation of ignorant or indif- 
ferent parents, — home and schools associations, public 
lectures, bulletins, exhibits, personal visits . • • 77) 

VI. Provision for Medical Aid 

Really expert medical service now available only for the 
very rich and the very poor. — Dangers of mediocre 
medical service and the need for adequate expert service 
for families of moderate income. — Experience of life 
insurance companies in furnishing free medical advice 
and treatment. — Plans for cooperation in securing com- 
petent medical, surgical, and dental service. — Drift 
toward public medical service ..... 84 

VII. Teaching Children the Art of Health 
Training children in the knowledge and practice of health 
laws and safeguards one of the most important func- 
tions of the school. — Scope and methods of instruction 



CONTENTS XV 

PAGE 

in hygiene and sanitation. — Sex instruction essential. 
— Psychological factors involved in successfully estab- 
lishing health habits, — example, motive, practice . . 103 

VIII. Health Supervision in Schools 

Five functions included in school health supervision, — medi- 
cal inspection, examination, and treatment; sanitary su- 
pervision of school buildings and homes ; hygienic regu- 
lation of school and home activities; health instruction 
of pupils and parents; physical education of children. 128 

IX. Scientific Management in Health Supervision 

Study of an actual medical and sanitary inspection system, 
and applications of efficiency tests. — Competent physi- 
cians and a well-devised plan not sufficient guarantees 
of effective work. — Accurate information regarding 
work done and results accomplished the basis for effec- 
tive supervision . • 147 

X. Red Tape 

Plan and forms for recording and summarizing facts re- 
garding physical examinations, recommendations for 
treatment, treatment obtained, inspection of school 
plant. — Method of using such records for directing and 
controlling inspection service ..... 174 



PART III 
A PROGRAM OF CHILD HYGIENE 

XI. Health Begins at Home 

The home as active as the school in producing physical de- 
fects of children. — Children in a large proportion of 
homes defective. — Parents generally unaware that it is 
necessary to study and practice child hygiene in bring- 
ing up children. — Account of actual cases typical of the 



xvi CONTENTS 

PAGE 

common failure of parents to realize that what seem 
grave constitutional defects are merely the result of vio- 
lation of health laws, — ill-selected or superfluous diet, 
imperfect mastication, bad ventilation, insufificient exer- 
cise or rest. — Responsibility of the family physician for 
teaching hygiene to his patients. — The underlying prin- 
ciples of wholesome living, simple and few . . . IQi 

XII. Air 

Air the most vital of physical necessities. — Much fatal illness 
due to unwholesome air. — A fresh-air regime necessary 
for the health of children. — How to secure it — sleeping 
porches, window tents, outdoor schools, proper house 
ventilation 203 

XIII. Food 

A specially selected diet necessary for children. — Necessity 
of making this highly nourishing and digestible. — 
Proper balance of food elements. — The value of various 
common articles of food. — Suggested menus providing 
food elements in proper proportions .... 217 

XIV. Clothing 

Comfort and cleanliness the two main considerations. — 
Clothing that protects sufficiently but neither constricts 
nor oppresses. — No arbitrary standard of children's 
clothing possible. — Choice to be intelligently made ac- 
cording to climate and vigor of children. — Use of the 
thermometer in regulating dress 233 

XV. Playgrounds 

Excessive housing, a danger of modern civilization. — Out- 
door play essential to children's healthy growth. — How 
to secure it. — Provision made for playgrounds in vari- 
ous cities. — The playground movement .... 243 



CONTENTS xvii 

XVI. Health Habits 

PAGE 

Habits that promote personal health. — Physical habits : 
breathing, eating, elimination of waste, exercise, pos- 
ture, cleanliness, rest. — Mental habits : cheer, courage, 
self-control. — Habits that promote community health : 
practices that prevent the scattering of unclean matter 
and disease germs ....... 259 

XVn. Calling the Doctor 

How to choose a physician. — Choice to be based upon the 
adequacy of his training, his professional standards, 
methods, and activities, and his acknowledged success. — 
— When to call a physician. — The meaning and gravity 
of certain symptoms ....... 283 

XVni. Health Problems in Children's Institutions 

The discussions in the preceding chapters all applicable 
to conditions in children's institutions or boarding 
schools, — additional problems involved in such institu- 
tions. — Methods of counteracting the undesirable efifects 
of herding children together night and day. — How to 
avoid contagion and the devitalizing eflfect of routine. 
— Institutional diet, clothing, and recreation . . 298 



PART IV 
SOCIALIZED HEALTH: A FORECAST 

XIX. The Relative Cost of Health and Disease 

Every step in the conquest of disease attended by an enor- 
mous saving in money and in human happiness. — 
Money efficiently spent for health conservation a highly 
paying investment. — Economics of disease prevention 
2 



xviii CONTENTS 

PAGE 

illustrated in Panama. — Health supervision in schools 
a fundamental and economical means of developing 
good health, and standards of healthy living, among all 
the people ......... 316 

XX. Compulsory Health 

Health important not merely to the individual and his fam- 
ily but to the community ; therefore a civic obligation 
as well as a right. — The work of home and school 
often undone by the failure of health officials to pro- 
tect the community from contaminated water and milk, 
unsanitary streets, sewers, public conveyances, smoke, 
etc. — The health problem of a community, of which 
school health supervision is but one part, to be consid- 
ered as a whole, each activity to be supplemented and 
supported by all the others. — A forecast : Every child 
with a sound physical inheritance and, from babyhood 
up, kept free from preventable defects and diseases. — 
Extermination of contagious diseases. — Sanitary school- 
houses, playgrounds, gymnasia, and swimming pools for 
100 per cent, of the children. — Municipal nurses, dentists, 
and physicians always available to give expert advice, 
instruction, and treatment as desired. — Dispensaries and 
hospitals adequate to the entire need. — Each school a 
center for health instruction not only for children but 
for adults. — Public and private agencies working to- 
gether in effective cooperation. — An educated and exact- 
ing public sentiment demanding thorough public en- 
forcement of the best sanitary standards . . . 340 



FULL-PAGE ILLUSTRATIONS 



FACING 
PAGE 

/ 



"Health and Happiness" ....... 52 

"There's No Fun Like Work" and "What Are They Rais- 
ing?" 60 

"Baby Saving Show, Philadelphia" ..... 200 

"Good Cheer and Health at Three Cents" . . . 218 '■' 

"Hitting the Health Trail" and "A Winter Prescription" 2,^6 - 

"The Eternal Spirit of Play" and "The Most Effective 

Argument for Playgrounds" ..... 252 

"On the Toboggan to Health" and "Bringing the Beach to 

the City" ......... 256 

"Every House a Home" ... ... 314 



/ 



PERSONS TAKING PART IN THE CONFERENCES 

Mr. Young. Superintendent of schools. He is trusted 
and admired by the whole town, and is regarded by his 
school board as a model of progressive efficiency. 

Mr. Martin. A member of the school board, also a 
widower with many cares. He is unenlightened, but 
eager to learn. 

• Mr. Ross. A self-made business man, satisfied with 
his work and with society. He is constrained by his su- 
perior wife to assume an active interest in all social wel- 
fare movements. 

Mrs. Ross. An awakening woman, whose husband's 
money has given her leisure to look around. This has 
aroused in her a sense of social responsibility. 

Miss Parsons. A social worker, whose active sym- 
pathies and penetrating mind command a following wher- 
ever she moves. 

Dr. Latta. a physician, new in the town. His elab- 
orate and spotless office equipment is the scorn of most 
of the old practitioners who view his new-fangled meth- 
ods and notable successes with jealous alarm. 



Health and the School 



ARE EDUCATION AND HEALTH INCOMPATIBLE? 

Mr. Young. — A profound movement, destined to ac- 
complish great results, is stirring our entire country. 
On every hand we hear the question, "How can we bet- 
ter our schools ?" As a people, we are finding out that 
popular education has not kept up with the procession. 
We see every day the last miracle of science or invention 
instantly appropriated by the industrial and commercial 
world. We see the efficiency of industrial institutions 
keyed daily to a higher and higher pitch. Why is it 
not so with our schools? Why do they not profit by 
the last scientific discovery or invention as do our rail- 
roads and factories and department stores? 

Is there no branch of science which can specially serve 
our schools, and whose every advance means equal ad- 
vance in our system of education? Though the schools 
have been slow to realize it, there is evidently one 
science, the most important of all, that is intimately con- 
nected with their efficiency. This science in its recent 
unprecedented development has benefited humanity far 
more wonderfully than any other. It is the science of 
medicine, the knowledge and control of health and dis- 
ease. Its discoveries lie at the service of our schools. 



2 HEALTH AND THE SCHOOL 

Healthful schools and healthy children have suddenly 
become the demand of the day. I believe we can have 
both, if we determine to; if we are willing to act on 
even a part of the modern medical knowledge that is 
ours for the asking. Like most school men, I have been 
long in waking up to this vital matter, which a recent 
experience revealed to me with sudden force. 

Last week my youngest little girl came running to 
me to know when school was to open. As she eagerly 
questioned the number of days before she was to enter 
school, and with forty other children be crowded into a 
classroom for long hours of weary work for young 
brains and little fingers, I wondered how long her cheeks 
would stay rosy and the spring in her step remain. I 
confess to my shame that I began to question whether 
I could not arrange to get her into some private school, 
where her physical comfort and welfare would receive 
more careful attention than her class standing. Then 
an accusing thought struck me. If I could not trust 
my own child's precious body to the schools that are 
under my direction, what about the 5,000 other young 
bodies that are gathered in these schools every day ? As 
the sense of this overwhelming responsibility came upon 
me I was stung with remorse, for I reflected that the 
most we had ever done for the physical welfare of these 
5,000 children was to see that the school buildings were 
sufficiently heated, and that contagious diseases were 
somewhat guarded against. 

While we have been patiently studying new ways of 
directing our long-suffering children's minds, we have 
never thought to find out whether the avenues to their 
minds were open; whether their eyes and noses and 
mouths and ears and brains were in shape to do business ; 
whether the physical conditions under which the chil- 



EDUCATION VERSUS HEALTH 3 

dren were working were the best possible ; whether the 
home conditions were wholesome; whether the children 
were learning habits of health. 

We school people have already far more educational 
theory than we practice, but do we know anything about 
the theory and practice of children's health ? I would 
not trust my little girl's physical care to any one who 
knows as little about it as I do. I have always left it to 
her mother and the doctor; but, heaven forgive me, for 
eight years now I have been partly responsible for the 
health of 5,000 boys and girls, and what have I been 
doing? What have we all been doing? Leaving the 
matter to Providence and the parents, many of them 
more ignorant than ourselves. 

We have calmly taken for granted that the general 
health of the children should decline through the win- 
ter, and that coughs and sneezes should punctuate all 
the recitations from autumn to spring. We have ac- 
cepted as inevitable the fact that June finds the children 
pale and nervous and worn, as they issue from the school 
mill which they entered so buoyantly in September. Now, 
I want to know whether this physical deterioration is a 
necessary price of education. I wish to lose no time in 
finding this out, for, if it is really so, I am not willing 
to continue in a business that actually damages children. 

I need help in investigating this question. I therefore 
propose that we devote the year's study to the health of 
children, in school and home; and that to-night we try 
to arrive at some conclusion concerning this question : 
Are education and health incompatible? 

Mr. Martin. — If Mr. Young's earnest words were 
not so evidently prompted by deep conviction, I should 
suppose he intended his gruesome question as a joke. 
Are education and health incompatible? How can they 



4 HEALTH AND THE SCHOOL 

be? Have not improved health and longer life followed 
step by step Mrith increasing education? 

Dr. Latta. — They have followed step by step with a 
certain form of education, that of the scientific labora- 
tory, which has indeed diminished disease and lengthened 
life; but our common schools are still producing quite 
reverse results, as they have always done. 

Mr. Martin. — I find it hard to follow you, sir; but 
if there is actually any ground for doubting the whole- 
someness of our schools, as a member -of the school 
board I want to know it. If my five children are likely 
to be physically handicapped through the very process 
of education I want a chance to think that over, too. 

Mr. Ross. — Now, before we let ourselves be carried 
ofif our feet by Mr. Young's enthusiasm, let us question 
a little the purpose of our schools. It is to teach, isn't 
it? Is it not stretching matters a little to demand that 
the schools should add to their already great responsi- 
bilities the care of the children's health ? Let the schools 
stick to their task of teaching which, with no disre- 
spect to anyone present, I may say they do none too 
well. 

Mr. Young. — Does Mr. Ross realize that one of the 
greatest single factors in keeping down the efficiency of 
our schools is the never-ending stream of absence, from 
which no class is free, and that absence in turn is largely 
due to sickness? If we are teaching none too well, which 
I grant, it is, partly at least, because we are teaching 
none too likely children. The sick absentees and the 
ailing children present are too often the pacemakers 
for their classes. It is not an inspiring idea. If, as 
Mr. Ross says, the business of the schools is merely 
to teach, our town will certainly not get its money's 
worth of teaching until the schools demand that the 



EDUCATION VERSUS HEALTH 



human material sent to them to work on is in as good 
condition as modern science knows how to make it. 

Dr. Latta. — That is far from being the case at pres- 
ent. Investigations under the Russell Sage Foundation 



- ■ ■ ■ ■ 



8 YEARS 


8.5 YEARS 


8.6 YEARS 


0.7 YEARS 


9.1 YEARS 


9.2 YEARS 


NO 

DEFECTS 


DEFECTIVE 
TEETH 


DEFECTIVE 
BREATHING 


HYPER- 

TROPHIED 
TONSILS 


ADENOIDS 


ENLARGED 
GLANDS 



THE HANDICAP OF PHYSICAL DEFECTS. 

The diagram shows the number of years required by defective and 
non-defective children to complete the eight elementary grades; 
according to data collected and published by the Russell 
Sage Foundation. 

indicate that not less than 6o per cent, of American 
school children are handicapped by removable physical 
defects, and that, as a result, they are making 9 per 
cent, slower progress in their studies than they should. 
Children with seriously defective teeth, according to 
these investigations, fall six months behind in eight 



6 HEALTH AND THE SCHOOL 

years. Half the school children of the nation— ten mil- 
lion — have bad teeth. Children with adenoids require 
a year and a month of extra schooling to complete 
eight grades. One-eighth of our twenty million children 
have adenoids. Children with enlarged glands require a 
year and two months over time. Nearly half of our chil- 
dren have enlarged glands. How much longer are we 
going to tolerate this enormous and unnecessary waste of 
time and educational effort, to say nothing of the vitality 
of the children? 

Mr. Ross. — Oh, doubtless children attending school 
ought to be kept in sufficiently good health to prevent 
them from wasting their time or that of their teachers 
and classmates ; but it is for parents and health boards to 
see to this, and not for the schools. Give teachers any 
discretion in these matters, and they will begin to usurp 
the authority of the home. They will soon be directing 
us when to put flannels on our children and what to give 
them for breakfast. 

Mrs. Ross. — I, for one, should not object to such 
consultations with my children's teachers. They care 
for the children through as many waking hours as I 
do myself. If they do not understand the physical care 
of children they ought to, for the children don't leave 
their bodies at home. 

Miss Parsons. — I think that all these vexed details 
of what is to be expected of the schools and the teachers 
will clear themselves if we return to the question Mr. 
Young proposed, "Are education and health incompat- 
ible?" I haven't the least idea that they are, if we 
have the right idea of education. But if, as I suspect, 
our present form of education is not compatible with 
health, must we not ask what is the great purpose of 
education, and how are our schools failing to serve it? 



EDUCATION VERSUS HEALTH 7 

The schools, as our special instruments of education, 
should undoubtedly provide or insist upon whatever 
makes for the best education, whether the necessary fac- 
tors are arithmetic books, baths, soups, or surgical op- 
erations. 

Mr. Ross. — What is the best education nowadays? 
It used to be a thorough knowledge of the three R's, 
the purpose being to enable children to get along. 

Miss Parsons. — Is not the purpose of education far 
more than that? Is it not to bring a human being to 
his highest possible state of healthful vitality and effi- 
ciency and human sympathy for the sake both of his 
own welfare and happiness and that of the community? 

Mr. Ross. — That is a beautiful thought. Miss Par- 
sons, but it is too much for a school to undertake. It 
requires educated ancestors and parents and money even 
to approximate such a product of sweetness and light. 
Neither physical nor spiritual perfection can be turned 
out by the gross from a public school. 

Miss Parsons. — But at least the product should not 
fall short of the Maker's pattern. If our schools cannot 
produce saints, or Samsons, they should, at any rate, 
graduate well-disposed, intelligent children, who are 
healthy. 

Mr. Martin. — Who knows that they do not? We 
are ready for some facts in this interesting discussion. 
Does our form of education damage our children, or does 
it not? 

Dr. Latta. — It does damage some of them, sir. Be- 
sides tolerating defects that could and should be re- 
moved, it produces certain ones. The impairment of 
vision, for instance, begins everywhere in the lower 
grades and continues increasingly to the top. These im- 
perfect eyes which the schools are making are the source 



8 



HEALTH AND THE SCHOOL 



of many constitutional ills that are not taken into account 
in public health reports. Headache, indigestion, nervous- 
ness, lassitude, and general misery are the price that a 
large number of our children are paying for the privi- 




A PUBLIC SCHOOL MAY BE A CENTER OF INFECTION AS WELL AS A 
CENTER OF INSTRUCTION. 

Every one of the twenty-two cases of scarlet fever indicated by 
the small circles was associated with the same school. Other 
schools in the same neighborhood were free from infection. 
This epidemic in Philadelphia was stopped when medical in- 
spectors located the scarlet fever carriers in the Thomas May 
Pierce school and put them under quarantine. 



lege of going to school and abusing their eyes. The 
eyes, moreover, are not the only organs that are injured 
in school, though the unscientific health inspection re- 
ports of many cities indicate nothing else. 



EDUCATION VERSUS HEALTH 9 

The backs that are twisted and bent by false positions 
and ill-adjusted desks are not usually mentioned. Nor 
is the connection often admitted between the annual crop 
of acute diseases and the schools that cause and foster 
them ; the fatal diseases of the respiratory organs, caused 
by bad ventilation and wrong systems of heating, and 
the inevitable contagious diseases that every mother ex- 
pects to invade her home as soon as the eldest child 
enters school. 

Do you know why I aim to be back in my ofifice every 
year at the opening of school ? For the reason that 
then the harvest begins, to keep up with little abate- 
ment till school closes in the summer. 

Mrs. Ross. — Has not the cold weather of these months 
as much to do with the increased sickness of the chil- 
dren as their school attendance. Dr. Latta? 

Dr. Latta. — Only in this way — that, as soon as frost 
comes, the windows in the schools, and in many of the 
homes, too, are practically sealed up. The children are 
forced to breathe unwholesome air, and the germs do 
the rest. The winter months should be the most health- 
ful of all the months in the year. The cold, clear air, 
free from many of the summer germs, is the best tonic 
we know, but we grudge it to our children both in school 
and home. 

At this point let me say that we must not lay all the 
ill health of our children to the school. The home is 
quite as responsible for it, and should come in for its 
full share of investigation; for, if there is one place 
less scientific than the school, in the care of children's 
health, it is the average home. 

Mr. Martin. — Returning to what Dr. Latta said of 
the medical inspection reports, his remarks seem to me 
to have little bearing on our local health question, since 



lo HEALTH AND THE SCHOOL 

we have no medical inspection in our town. For aught 
we know the condition of our school children is better 
than that of children in other towns. 

Mr. Young. — True — and, for aught we know, it is 
worse. We ought to know whether it is or not. We 
cannot let civic pride take the place of information on 
this subject. 

Miss Parsons. — Is not the purpose of our club to 
gather and use just such information? Shall we not 
arrange with the help of competent physicians to find 
answers to the following questions : 

1. What is the present physical condition of our school 
children? How can it be improved? 

2. What are the conditions under which the children 
are living and working in home and school? How can 
these conditions be improved? 

3. How can we enlist the teachers, the parents, and 
the children of this town in a children and health for- 
ward movement? 

Mr. Young. — You have offered us a valuable pro- 
gram, Miss Parsons. In carrying it out our club will 
render a great service to the town. As our time for 
closing is at hand, I will sum up in a few words the 
result of our evening's discussion : 

Dr. Latta has made it clear that education, as it is 
now conducted in the public schools, is actually incom- 
patible, at many points, with the health of our children. 
Not only are the schools failing to foster and develop 
health, but to some extent they are undermining it. 

There seems further to be an agreement on these 
fundamental matters : 

That the aim of education in school or home is to 
prepare adequately for an efficient and well-poised life. 

That health is an indispensable factor in such a life. 



EDUCATION VERSUS HEALTH ii 

That there is no duty more pressing in the school or 
home than that of securing the best health possible for 
children. 

Suggested Reading 

Allen. Civics and Health. 

American School Hygiene Association. Proceedings 
OF THE Fifth Congress. What Our Cities Are 
Doing for the Health of Our Children. 

GuLiCK and Ayres. Medical Inspection of Schools, 

1913- 

Hogarth. Medical Inspection of Schools, Chapters HI- 
VI. 

Russell Sage Foundation. 

Money Cost of Repetition Versus Money Saving 
through Acceleration. 

The Relation of Physical Defects to School Prog- 
ress. 



II 

HEALTH CENSUS OF A SCHOOL 

Mr. Young. — "The schoolboy with his shining morn- 
ing face" has stood for generations as a symbol of the 
happiest, healthiest life in the world. How does this 
child of the poet's fancy stand up under scientific in- 
vestigation? What is his status in our town? We have 
been making a few inquiries about the shining appari- 
tion. Miss Parsons will report the result. 

Miss Parsons. — I shrink from saying anything to take 
the shine off; and were it not for the hope of convert- 
ing the poet's fancy into actual truth I should much 
prefer to cherish, undisturbed, the illusion of his highly 
vitalized schoolboy. As a matter of fact, however, we 
have found few traces of this boy. Eight or nine in 
every ten of our school children need either the doctor 
or the dentist or the oculist. 

Mr. Ross. — Impossible ! 

Miss Parsons. — So I should have said a month ago-, 
but our investigation has left no room for question. It 
is true that we have thus far investigated only one 
school, our purpose being to develop experimentally a 
model for further work in the entire school system ; but 
the Washington school which we chose is typical of all 
the other schools in town, apd for that matter probably 
of schools throughout the country wherever communi- 
ties have been as backward in school health matters as 
we have. 

12 



HEALTH CENSUS OF A SCHOOL 



13 



Dr. Latta. — That means almost sixty per cent, of our 
cities, and even more of our country communities. 

Miss Parsons. — The actual work of examining the 
children was done 
by three of our best 
known and most 
trusted physicians. 
After careful con- 
sultation they de- 
cided exactly what 
standards of health 
to follow, just what 
defects to look for. 
In a number of 
cases all three phy- 
sicians examined the 
same child, to make 
sure that all were 
accurately observing 
the same standards. 
I mention the con- 
scientious care 
taken by these phy- 
sicians to make it 
possible for you to 
believe their incredi- 
ble report. 




PHYSICAL RATING OF 20,000,000 
SCHOOL CHILDREN IN THE UNITED 

STATES. 

The dark section represents 12,000,000 
children (60%) who have defects so 
serious as to interfere materially with 
their physical growth and to retard 
their school progress by from 6 to 
15 per cent. The shaded section 
represents 4,000,000 children (20%) 
who have less serious defects. The 
white section represents 4,000,000 
children (20%) who are physically 
sound. [According to data published 
by the Russell Sage Foundation.) 



The general; re- 
sult of the investigation you have already heard. Almost 
nine out of every ten children in the Washington school 
were found in need of treatment. There is, however, a 
very hopeful side to this dark picture. Most of the de- 
fects we found can readily be corrected. Intelligence in 
their detection and treatment, and, most of all, in their 



14 



HEALTH AND THE SCHOOL 



prevention, can easily free the children from them, and 
keep them free. That makes our duty toward these chil- 
dren very clear. 

Of the 468 children examined 412 needed treatment 
for one or more defects. The defects themselves num- 
bered 879, which showed an average of 2.13 defects to 
each child needing treatment. The distribution of defects 
was as follows : 

CHILDREN FOUND NEEDING TREATMENT * 
468 CHILDREN EXAMINED 



DEFECT 



Defective Vision 

Defective Hearing 

Defective Nasal Breathing, 

including Adenoids 

Hypertrophied Tonsils .... 

Enlarged Glands 

Pulmonary Disease 

Cardiac Disease 

Nervous Diseases 

Orthopedic Defects 

Anaemia 

Malnutrition 

Defective Teeth 

Defective Palate 



NUMBER OF CHIL- 
DREN NEEDING 
TREATMENT 


PERCENTAGE 
OFWHOLE NUM- 
BER EXAMINED 


144 


30.7 


6 


1.2 


138 


29.4 


116 


24.7 


I 


0.2 


12 


2.5 


I 


.2 


22 


8.9 


n 


16.4 


21 


4-4 


318 


67.9 


3 


.6 



Mr. Ross. — May I interrupt the proceedings to in- 
quire whether having all these modern defects is as 

* Based upon a report of the New York Bureau of Municipal 
Research : A Bureau of Child Hygiene, September, 1908. i 



HEALTH CENSUS OF A SCHOOL 15 

bad as it sounds ? Why should we be so concerned about 
them? Toothaches and growing pains and other such 
uncomfortable things are necessary incidents to child- 
hood. We all had them once, but they soon passed by 
without any medical treatment. 

Dr. Latta. — Too many of our childhood friends 
passed by, too, without medical treatment, Mr. Ross. 
The graveyards are full of them. 

Mr. Ross. — But the children who died had something 
the matter with them, Dr. Latta. It took a fatal disease 
to remove a child in my day. Little walking defects that 
don't keep children home from school aren't going to 
carry them to the churchyard, are they? 

D'R. Latta. — Not at once, Mr. Ross, but they lead 
the way. Scores of children will die this year in our 
town, and most of them will have a record of little de- 
fects neglected. 

A decayed tooth is not so bad as a decayed appendix, 
but it is constantly filling the whole alimentary system 
with putrefactive germs. An adenoid is not so deadly 
as pneumonia, but it does reduce the air supply, which 
prevents the blood from discharging its poison. It thus 
invites pneumonia and the whole collection of respiratory 
diseases. When the fatal disease you spoke of is look- 
ing for a victim, what likelier one can it find than a 
young constitution struggling under the handicap of un- 
aerated blood or an alimentary canal full of decay? 

Mr. Ross. — That is the sort of thing I wanted you to 
bring out. Dr. Latta. Do you actually believe that there 
is a very close connection between these slight defects 
and the serious diseases? 

Dr. Latta. — I know it, sir. 

Mr. Ross. — Then let us hear more about them and 
how to rid the children of them. 



i6 HEALTH AND THE SCHOOL 

Miss Parsons. — How to rid the children of their 
physical defects is, of course, one of our great problems. 
How to prevent defects is a still more important one. 
We are beginning with the first problem in the Wash- 
ington school, and succeeding beyond our hopes. At 
a later meeting we shall tell of our methods and results. 
You will now want to hear something about the nature of 
the defects that were found. Dr. Latta will give us a 
brief account of them and of their constitutional results. 



DEFECTIVE TEETH 

Dr. Latta. — You see by the table which Miss Par- 
sons has just shown you that the greatest number of 
defects found are in the children's teeth. Defective 
teeth are of two kinds, malformed and decayed. I 
might add a third kind, missing teeth, which are piti- 
fully numerous. Whatever is wrong with the teeth, 
whether it be malformation, decay, or absence, inter- 
feres with their prime business, which is to chew food, 
and with the aid of the saliva partially to digest it. To 
swallow food that is not thoroughly masticated imposes 
an enormous strain upon the digestive organs, which 
never fail at some time to exact their reckoning. 

The first mentioned tooth defect, malformation, often 
does more than interfere with chewing. Protruding 
teeth, which keep the mouth from closing, besides mak- 
ing proper mastication out of the question, prevent nasal 
breathing — the only right way of breathing. Aside 
from hygienic considerations, deformed teeth are an in- 
tolerable social oflfense as well as a mortifying and un- 
necessary handicap to their possessors. We should not 
compel our children to view such unsightly defects 



HEALTH CENSUS OF A SCHOOL 17 

among their companions, and we should certainly save 
the unfortunate children who have them from their so- 
cially demoralizing' effects. 

Mr. Martin. — Is there any help for bad cases of pro- 
truding teeth? 

Dr. Latta. — Assuredly. A good orthodontist can 
completely make over the shape of a mouth ; but unfor- 





PHYSICAL COMELINESS A PERMANENT ASSET. 

Every child has a right to be relieved of the unnecessary handicap 
of removable physical defects such as distorted jaws and teeth. 
The drawing shows results actually brought about by an ex- 
pert dentist. 

tunately the technique of teeth-straightening is not given 
much attention in most of our dental colleges and there 
are few men really skilled in the art. On the other hand 
there is no defect in teeth that is easier to avoid by pre- 
ventive measures than the unnatural protrusion of the 
upper teeth. I shall say more about this matter when 
I speak of adenoids. 



i8 HEALTH AND THE SCHOOL 

Decayed teeth need little description. When the decay 
is advanced, they proclaim themselves by their offensive 
odors and are easily recognized by any one who takes the 
trouble to look at them. I have already alluded to them 
as serious sources of intestinal infection. Few people, 
however, realize that they are. Everybody is a little 
careful not to eat decayed food if he can help it, but 
what earthly good comes of this precaution when decay 
is already present in the mouth ? 

Mr. Ross. — Only today I happened to hear that the 
best professional ball players put the same value on sound 
teeth that you do. The manager of one of our leading 
teams has announced that he intends to take a dentist 
along with him on his annual Southern training trip. 
He says he has found that most of the stomach troubles 
which bother young players are entirely due to poor 
teeth. 

Dr. Latta. — Those men know they can't play good 
ball with poor teeth. Let us see now what happens when 
decay goes so far as actually to destroy the teeth. 

When a deciduous or baby tooth goes prematurely, the 
result is often shown in a malformed jaw and imper- 
fect second teeth. That is bad enough, but when a per- 
manent tooth is lost its owner has parted forever with 
a good-sized block of his vital securities. Undue work 
is thrown on his other teeth, the teeth in his impaired 
jaw are thrown out of bearing, his whole mouth is 
crippled, and he limps when he chews. The stomach 
complains at this unfair arrangement and retaliates in 
the form of dyspepsia. 

"If I were asked to say whether more physical de- 
terioration were produced by alcohol or by defective 
teeth, I should unhesitatingly say defective teeth." This 
is the declaration of Dr. Osier, a world-wide medical 



HEALTH CENSUS OF A SCHOOL 19 

authority. Sixty-eight per cent, of the Washington 
school children are now suffering such physical deterio- 
ration. Bad teeth should be tabooed in our schools, as 
is the presence of head lice. The latter infection is 
counted a disease and disgrace; but does it compare 
either in offensiveness or danger with the disease and 
disgrace of rotten teeth that are poisoning their pos- 
sessors and filling the air with intolerable odors ? 

Mr. Martin. — Your words give me great concern. 
Dr. Latta. I shall send all my children to the dentist 
to-morrow, and yet, if I were to do that every time their 
teeth bothered them, I couldn't afford to keep them in 
shoes. Dentists are too great a luxury for most people. 
How are the unfortunate 68 per cent, in the Washington 
school going to have their teeth attended to without 
cutting down their supply of oatmeal and overcoats? 

Mr. Young. — You have brought up a very serious 
problem, Mr. Martin. The present cost of dental work 
is indeed prohibitive for the great majority of people. 
It will have to be adjusted before vv^e can expect our 
school children all to have good teeth. It is a question 
with which our club must some day grapple. 

Dr. Latta. — In the meantime children can help them- 
selves out wonderfully by keeping their teeth clean. If 
the teachers and the parents had seen that they were 
doing this every day, there would not have been 68 per 
cent, of children with bad teeth in the Washington 
school. 

DEFECTIVE EYES 

Dismissing the question of teeth for the present, we 
will turn our attention to eyes, which you noticed stood 
second in the list of defective organs found. Many of 



20 HEALTH AND THE SCHOOL 

these eye defects are very simple, easily detected and 
corrected. The inconvenience and misery that they 
cause are indeed out of all proportion to the ease with 
which they can be removed or prevented. There are 
four main defects of vision that give almost all the 
trouble. These are: short-sightedness (myopia); far- 
sightedness (hypermetropia) ; astigmatism, an irregular- 
ity in the cornea, resulting in uneven and blurred vision ; 
and weakness of the eyes, due to over-use, or poor light- 
ing and print, or low constitutional vitality. These are 
all alike in their results on the children. They all cause a 
nervous strain which shows itself in various ways — 
headache, stomach trouble, lassitude, irritable temper, 
and general nervousness. 

The effect of correcting eye troubles is almost magical. 
It is not unusual for a disposition which has been the 
parents' despair to be completely transformed, simply 
by lifting the unconscious strain from the long- suffering 
child. There is no treatment that can be given to school 
children with such ease and at the same time with such 
valuable results as correcting and preventing eye de- 
fects. 

ADENOIDS AND HYPERTROPHIED TONSILS 

Next on the list, only i per cent, below defective 
vision, comes defective nasal breathing. This in most 
schools reaches a higher percentage than does defective 
vision, and it is even more serious in its consequences. 
Defective nasal breathing is almost always due to the 
presence of the much-talked-of adenoid; and that in- 
truding nasal growth, along with the hypertrophied ton- 
sil, is the bane of the primary schoolroom, afflicting the 
younger children far more generally than the older ones. 



HEALTH CENSUS OF A SCHOOL 21 

You observe in the table that the cases of hypertrophied 
tonsils were only slightly fewer than those of defective 
nasal breathing. The two defects very often go together, 
and when they do they keep their victim half stifled. 

This is the day of fresh air agitation. We hear much 
about sleeping porches, open-air camps, and even out- 
door schools, but the child with adenoids cannot breathe 
the fresh air when it is offered to him. The adenoids 
in the nasal cavity partly or wholly cut off the supply 
of air through the nose, which throws the business of in- 
haling air upon the mouth, a function for which the 
mouth was never intended. 

Mr. Martin. — Why not? I've heard much about the 
evil of mouth-breathing, but why is it really so bad ? 

Dr. Latta. — In the first place, it is a constant strain 
and discomfort to force air through the mouth, and the 
inhalations are ordinarily not so deep as wh^n taken 
through the nose which, of course, means a reduction 
of the air supply. Put a clothes pin on your nose for 
five minutes and find out for yourself some of the dis- 
comforts and limitations of mouth-breathing. The most 
tangible evidence of the harm of this practice is the 
surely resulting distortion of the jaws, especially the 
upper jaw, and indeed the entire face. The unfortunate 
children and grown people, too, whom you see with pro- 
truding upper teeth and jaws, are almost invariably vic- 
tims of the mouth-breathing habit. 

Mr. Martin. — How can such a simple thing as hold- 
ing the mouth open cause a change in bony structure ? 

Dr. Latta. — Very easily indeed. A little pressure con- 
stantly applied to a growing bone can modify its shape 
greatly. When the mouth is closed the cheeks and tongue 
and lips are all exerting normal and balanced pressures 
upon the jaws. When the mouth is open the pressure 



22 HEALTH AND THE SCHOOL 

of the lips and the tongue is removed, the cheeks only 
continuing to press from either side. This results in the 
narrowing and protruding of the upper jaw, and to some 
extent, of the lower jaw, a phenomenon with which you 
are all painfully familiar. 

To continue now with the causes of defective breath- 
ing, when enlarged tonsils are also present they further 
obstruct the inhalation of air, and the process of breath- 
ing, which should be a delight when it is conscious at all, 
is a dull chronic misery. Children with breathing thus 
impaired show all the symptoms of partial suffocation, 
sluggishness of mind and body, pallor, nervousness, and 
a general feeling of ill will toward their companions and 
surroundings. 

Normal growth cannot go on when the blood lacks 
the normal amount of oxygen, and unless the obstruc- 
tions to breathing are removed or outgrown their vic- 
tims never reach full stature. In addition to those se- 
rious constitutional derangements, adenoids and enlarged 
tonsils bring about definite diseases. Their congested 
tissues are excellent pastures for germs. Colds and sore 
throats in steady procession visit the adenoid child, who 
is thus a constant source of infection to his school mates. 

While all these results seem bad enough, perhaps the 
very worst effects of obstructed breathing appear in 
the minds and characters of the affected children. It 
is hard for children with obstructed breathing to be good. 
In fact, the proportion of nose and throat defects among 
delinquent children is invariably much higher than 
among well-disposed children. One school principal of 
my acquaintance, when a child was sent to his office 
for discipline, made it his regular practice to look first 
into the child's mouth. He rarely failed to find the 
tell-tale tonsil. He does this no more, however, for, 



HEALTH CENSUS OF A SCHOOL 23 

by enlisting the interest of the parents, he succeeded in 
ridding his school of both adenoids and enlarged ton- 
sils. The problems of discipline were removed at the 
same time. 

The four kinds of defects we have thus far discussed, 
those of teeth, eyes, nose, and throat, not only on ac- 
count of their seriousness, but on account of the great 
numbers in which they occur, are those of the greatest 
importance from the standpoint of the school. They 
moreover come easily under the control of school author- 
ities, as their corrective treatments are in general simple, 
and not likely to be much hindered by parental oppo- 
sition. It would be well to add the caution, that, while 
the removal of adenoids and tonsils involves but simple 
operations, it is of the utmost importance that these be 
skillfully done. No operations should be urged upon 
school children unless it is made sure that they will be 
in charge of competent specialists. 

The other defects in our list, while much fewer, are 
not slight ones either from the standpoint of the school 
or of the afifected children. The school cannot afford 
to drag along one child whose power is impaired through 
needless disease, and not one child can afford the un- 
necessary burden. 

ANEMIA 

The next disease on our list, anemia, is a scanty or 
impoverished condition of the blood, which shows itself 
by an unnatural pallor. It produces constitutional symp- 
toms like those caused by adenoids and defective eyes. 
Weakness, pains in the head, poor sight, and impaired 
digestion are the trials of anemic children. Work and 
play have little joy for them, and mere living is an ef- 
fort. Cases of anemia that are not caused by organic 



24 HEALTH AND THE SCHOOL 

disease can be cured and prevented by supplying the 
right Hving conditions — proper food, air, and rest. 

ORTHOPEDIC DEFECTS 

The orthopedic defects come next, with a record of 
9 per cent. Curved spines are the chief orthopedic 




AS THE TWIG IS BENT. 

School desks that are too high or too low cause mishapen spines. 

troubles that appear in schools. Many of these twisted 
backs are caused by wrong school conditions, ill-fitting 
desks, over-prolonged desk work, carelessness of posture, 
and neglect of exercise. The school should give special 
regard to orthopedic defects, with a view not only to 
their cure, but more particularly to their prevention. 

The school years, which are the growing years, make 
or mar the body. Like a young tree, a child's back is 
taking on its permanent shape. It can easily be modi- 



HEALTH CENSUS OF A SCHOOL 25 

fied at this time, and to let it settle into a false curve 
is to do the child irreparable injury. He loses not only 
the possibility of ever attaining a fine posture and bear- 
ing, a most important factor in his future success and 
happiness, but he suffers a permanent impairment of 
health. No vertebra can remain turned or slipped from 
its proper place without setting up an irritating pres- 
sure on nerves or organs, which results in a life-long 
nervous strain, if not in actual organic disease. 

Defects of feet, particularly flat-foot, due to a weak 
or broken-down foot arch, are a condition too seldom 
recognized among school children. So-called growing 
pains in instep, sole, ankle, knee, or hip are often symp- 
toms of flat-foot. The condition requires thorough in- 
vestigation and the advice of a specialist, as chronic 
discomfort, stiffness, and weakness, with attendant nerv- 
ous strain, are the consequences of neglecting or wrongly 
treating this defect. 



MALNUTRITION 

Defective nourishment is next on our list. Our schools 
as now organized cannot be held accountable for this 
trouble, as they can for orthopedic and eye defects, but 
they should take note of all cases and set the proper 
agencies at work to cure them. Some cases of malnutri- 
tion are due to actual disease, and should be kept in 
the hands of doctors. Many are due to poverty, and 
these should be handled for the time being by charity 
organizations. Many, however, are due to mere igno- 
rance of parents as to the right diet and hygienic habits 
for their children. It is with such cases that the school 
could and should wield a strong and beneficial influence. 



26 HEALTH AND THE SCHOOL 

CARDIAC DEFECTS 

Heart troubles are found in small numbers in most 
schools; the proportion in the Washington school being 
2.5 per cent. Children having such defects should be 
pronounced upon by an expert and have their activities 
regulated under his advice, as certain forms of play and 
exercise, normal enough for normal children, often cause 
the affected children great harm. 

DEFECTIVE HEARING 

Deafness we found in 1.2 per cent, of the children. 
This trouble is often caused by catarrh of the middle 
ear, which, if neglected, may develop into mastoiditis, a 
dangerous inflammation in the bone behind the ear. 
Deafness is also caused by the presence of adenoids, and 
may be corrected by their removal. Nothing should be 
left undone to relieve children of defective hearing at the 
earliest possible moment. It may soon become too late. 

DEFECTIVE PALATES 

Cleft palates were found in three children, these being 
0.6 per cent, of the entire number. Skillful surgical 
treatment is the only help for unfortunate cases of this 
kind, and little can be done even by surgeons after in- 
fancy. 

PULMONARY AND NERVOUS DISEASES 

Any form of either pulmonary or nervous disease is 
serious and difficult to handle. Children suffering from 
such a disease should remain away from the ordinary 
school until cured. 



HEALTH CENSUS OF A SCHOOL 27 



ENLARGED GLANDS 

Swollen glands were among the defects we looked 
for. Though we found many cases of slightly enlarged 
glands, none was serious enough to report. In most 
cases enlarged glands are symptoms of other defects, 
such as bad teeth, hypertrophied tonsils, and pediculosis 
(head lice). The glands return to their natural size and 
condition as soon as the causal defects are removed. 
Glandular enlargement must never be overlooked, how- 
ever, as it is always an indication that the bodily nutri- 
tion is being interfered with, and that the poisons which 
accumulate in the tissues are not being properly dis- 
posed of. This state of the glands furnishes exactly 
the right soil for tuberculosis. When glandular enlarge- 
ment continues and increases it usually means a serious 
case of this dreaded and dangerous disease. 

SUMMARY 

This completes the list of physical defects which we 
selected for the test of the Washington school children. 
The list is extremely conservative. To avoid opposition 
to the experiment, we omitted several defects which 
should properly have been included in it, such as mental 
deficiency, defective speech, non-infectious skin diseases, 
hernia, and phimosis — a constricted condition in boys, 
curable by circumcision, and likely to produce nervous 
derangements as well as hernia if neglected. Our survey 
also took no account of the minor contagious diseases 
which we incidentally met in great numbers — pedicu- 
losis, ringworm, scabies, impetigo, — nor of the venereal 
diseases sometimes found among school children. All 



28 HEALTH AND THE SCHOOL 

these defects and diseases of school children, together 
with the best ways of discovering- and handling them, 
have been described with great clearness in several re- 
cent works to which I shall refer you. 

The list of defects which we have considered to-night, 
though only partial, is long. You have seen the se- 
rious consequences involved in letting them go uncor- 
rected, and at the same time you have seen how easily 
removed or prevented many of them may be. Do you 
think the school, which is responsible for many of them 
and handicapped by all of them, can any longer afford 
to ignore them? Must it not use all its influence and 
authority to secure their rernoval and prevention? 

• Suggested Reading 

Allen. Cizncs and Health, Chapter VI. 

American School Hygiene Association. Proceedings 
OF the Fourth Congress Contagious Skin Dis- 
eases in Relation to Schools. 

Hoag. The Health Index of Children. 

Hogarth. Medical Inspection of Schools, Chapter 
XVL 

National Society for the Study of Education. The 
Ninth Year Book. Part I, Health and Education. 



Ill 

SANITARY INSPECTION OF A SCHOOL BUILDING 

Mr. Young. — What ails our children? When we 
heard that question answered at our last meeting we 
were all thoroughly shocked. There is another ques- 
tion fully as urgent. Its answer is no less shocking. 
What ails our school buildings? Mr. Martin will ex- 
plain. 

Mr. Martin. — It is a penance for me to give an an- 
swer, for I am in a measure responsible for the condition 
we found at the Madison school. For five years I have 
been on the school board, and not till last month did 
I know, or know enough to care, what condition our 
buildings were in. It is true that I did not chance to 
be a member of the committee on buildings, but that 
was no excuse. 

When we came to examine the Madison school build- 
ing, outside and inside, with respect to its site and sur- 
roundings, its heating, ventilating, lighting, sanitary ap- 
pliances, and care, we made the following discoveries* : 

The building is a two-storied frame structure with 
no fireproofing, but with ample outside fire escapes. Its 
location is bad, being near a gas plant which constantly 
fills the air with unwholesome odors. 

* Based upon an investigation of the sanitary conditions of a 
school building, by W. E. McGowan, reported in the Pedagogical 
Seminary, December, 191 o.^ 

4 29 



30 HEALTH AND THE SCHOOL 

The ground on which the building stands is low and 
ill-drained, which makes the fair-sized yard unfit to 
play in during much of the year. Part of the yard is 
fenced ofif for lawn and shrubbery ; the ornamental effect 
thus secured being paid for by the children in narrowed 
space for play or gardening. 

The heating of the building is by means of the hot- 
air gravity system, the warm air inlets being in or near 
the floor. We found the heating system to be effective, 
so far as temperature was concerned. The thermometer 
stood at about 70 degrees in all the schoolrooms, and the 
teachers reported little trouble, even in zero weather. 

Getting air heated, however, seems to be a far less 
important matter than keeping it sufficiently fresh and 
moist. It is an easy thing for children to exercise or 
put on wraps if they are cold, but they have no protec- 
tion against air that is poisoned, or so dry from heating 
that it blisters the delicate membranes of nose or throat. 
It was in its failure to assist the ventilating system that 
the heating system in the Madison school broke down. 

Ventilation has been a general theory for many years ; 
a general practice never. We found it in its theoretical 
state in the Madison school. At one time a ventilating 
system had been installed and then forgotten. This sys- 
tem still stands as our fathers left it. It was not work- 
ing when we saw it, never had been working, and the 
janitor did not know of its existence. 

The system included an outlet flue in each room. 
These flues were for conveying foul air into a central 
chimney — too small for the purpose — which had been 
used as a smoke flue when the building was heated by 
stoves. . Our anemometer tests, taken with windows both 
open and shut, showed that no foul air was being con- 
veyed through the outlet flues to the central chimney. 



SANITARY INSPECTION 31 

We discovered the reason for this total failure of the 
outlet flues when we inspected the bottom of the chim- 
ney in the basement. Set in the base of the chimney- 
was a stove which once had been put there to furnish an 
upward current of air. The stove had never been used; 
the janitor did not know what it was for. 

In many rooms we found slightly opened windows, 
which gave an appearance of good ventilation, but an 
appearance only. Our anemometer tests showed that 
the quantity of fresh air admitted into the rooms fell 
far short of the amount required by our State school 
regulations governing the construction of new buildings. 
This is 1,800 cubic feet per hour per pupil. The greatest 
amount of air admitted in any room in this school was 
1,100 cubic feet. 

With the ventilating system in the dormant condition 
just described, the only way that good, as well as warm 
air could have been provided in the building would have 
been through a miracle. No miracle had taken place 
when we visited the school, and the air was what might 
have been expected — intolerable. 

Mr. Ross. — I should like to ask just how you were 
able to find that out. Was it by the odor of the air? 
There is, of course, always an odor in schoolrooms and 
children's institutions. This seems harmless enough, and 
it cannot be avoided where you have so many children 
together. 

Mr. Martin. — I do not agree with you there, but the 
odor in this case, I assure you, was quite sufficient to 
indicate the bad quality of the air. We did not depend 
upon that, however. Our conclusions regarding the 
amount of organic matter in the air were based upon the 
amount of carbon dioxide (CO2) which it contained. 
The excess of CO2 in air that has been breathed is a very 



32 HEALTH AND THE SCHOOL 

accurate index of the amount of organic matter that 
has been exhaled. We measured the proportion of CO2 
in the air very carefully by the Petterson-Palmquist ap- 
paratus, which registered an amount greatly exceeding 
the present generally accepted limit for health ; i. e., 10 
parts in 10,000 of air. Our tests showed that the pro- 
portion of COo in the school air increased steadily after 
the opening of school to 20 or 24 parts per 10,000. The 
pupils were breathing what would be technically ranked 
as bad or very bad air throughout their school day. As 
these tests were conducted in weather moderate enough 
to allow of the windows being partly open all day, it is 
interesting to consider what condition the air of that 
school reaches in really cold weather. At this point I 
must admit, however, that, according to recent experi- 
ments, the COo test is not an altogether infallible index 
to the wholesomeness of air. We will discuss this ques- 
tion more fully later.* 

There is a further factor necessary to air that meets 
modern standards and as to this the experts leave us in 
no doubt. It is moisture, a condition fully as important 
as purity. Heated air has to be humidified. 

Mr. Ross. — Oh, come, Mr. Martin, isn't that carrying 
a fad too far? They will want us to perfume the school 
children's air next. We all know that damp air is deadly. 

Dr. Latta. — Not so deadly as air that is too dry, Mr. 
Ross. 

Mr. Martin. — I confess that when humidity as a fac- 
tor in ventilation first came to my attention I thought 
the emphasis which some of the school agitators placed 
upon it was rather far-fetched. Why good, dry air 
should be made artificially damp was more than I could 
see. When scientific facts clash with opinions, however, 

* See page 46. 



SANITARY INSPECTION 33 

it is the opinions which have to give way, as mine have 
now done. I learned that eggs in an incubator never 
hatch unless the air is humidified to the right degree; 
that even cactus plants succumb to the air of our furnace- 
heated houses. I noticed that my children wilted like 
cut flowers when they were kept indoors a single whole 
day in the winter, though the air in our house is fresh. 
Then I concluded that there was some point to all the 
recent humidity agitation. 

Mr. Ross. — I don't understand this at all. How can 
house air in the winter be so much drier than outdoor 
air? The air we have in the house all comes in from 
outdoors, doesn't it? Why doesn't the moisture stay the 
same? 

Mr. Martin. — When air is heated its capacity for 
moisture increases enormously. Unless additional mois- 
ture is supplied artificially the relative humidity becomes 
very low, and the air absorbs whatever moisture comes 
in its way. In our houses such moisture is supplied 
principally by the membranes of our noses, throats, and 
lungs. Not being constructed for this purpose, the mem- 
branes become parched. The results are colds, sore 
throats, and universal catarrh. My children have never 
been free from these troubles during cold weather. Ex- 
periments have conclusively proved that it is not the 
winter weather but the roasted indoor air of winter that 
gives the germs their chance. 

Humidification of air was a foreign thought to 
the janitor of the Madison school, and we accordingly 
found nothing of the sort being done. The lack of 
moisture in the air was made evident by our hygrometer 
tests, which showed the amount to be only 24 per cent. 
Ordinary outdoor humidity is not far from 60 per cent. 
Indoors it cannot go below 40 per cent, without serious 



34 



HEALTH AND THE SCHOOL 



harm resulting. What do you suppose is the effect when 
the percentage of moisture has shrunk to about half the 
minimum limit for health? 




HYGROMETER. 

This instrument for measuring the amount of moisture in the 
atmosphere should be part of the equipment of every school. 

Noisome and parching air was what we found in this 
school. School children in all parts of our country are 
breathing the same kind of air. 

The lighting arrangements had been fairly well planned 
in the construction of the building, the ratio of glass 



SANITARY INSPECTION 35 

to floor space being within the very moderate i to 6 ratio 
prescribed by law. The placing of the desks was also 
proper, except in one room, where the light came from 
the back instead of from the left, or the back and left, 
with a preponderance of light from the left. 

Aside from these general arrangements, however, no 
thought seemed to have been given to the important 
matter of illumination. Though the seats for the most 
part were rightly set, the children were assigned to 
them with no regard to the lighting. There were empty 
seats in the best lighted places, and no effort had been 
made to seat children with respect to any visual defects 
they might have. 

While the ratio of window space to floor space was 
within the legal limit, we found that the light which 
should have been admitted was reduced in several ways. 
Large trees in the school yard stood near some of the 
windows, cutting off the light. The windows themselves 
were all dirty, which materially reduced the illumination. 
The shades were carelessly adjusted, some being broken 
and impossible to raise. Some of the windows were filled 
with plants which absorbed about a quarter of the light. 
You may wonder how plants could live in the abnormally 
dry air we found. It was, indeed, only by being con- 
stantly soaked with water that they did survive, and this 
constant soaking of the plants actually increased the 
humidity of the air in the rooms where they grew. 

The sanitary appliances and practices in this building 
we found as follows : 

The toilet rooms, which were unheated, were placed 
in a well or shaft inside the building, and illuminated 
only by skylights at the top of the well. The ventilation 
was supposed to be carried on through swinging sash 
windows. 



36 HEALTH AND THE SCHOOL 

Now, there are four prime requisites for proper sanita- 
tion of toilet rooms. These are cleanHness, direct il- 
lumination from the sun, ample heating, and a continu- 
ous supply of air, preferably by a special system of as- 
pirating chimneys and exhaust fans. These well-known 
principles of hygienic construction were all being vio- 
lated in the Madison school building. There was no 
sun, no heat, no ventilation. The odor from the toilets 
permeated the whole school. 

The drinking and washing facilities evidenced strik- 
ing disregard of sanitation. The common drinking cup 
and towel were still in use as they were a generation 
ago, though it is everywhere known what spreaders of 
contagion these filthy things are. A recent test made 
on a common drinking glass from a school showed lOO,- 
Goo bacteria to a square inch of glass surface, and the 
upper third of the glass so thickly strewn with skin cells 
from the lips of the children that a pin point could not 
be touched to any part of the glass without coming into 
contact with several bits of skin. 

The manner of cleaning a school is of great impor- 
tance from a sanitary point of view. This can be so done 
as to result in greater harm than benefit, and so we found 
it in the Madison school. The floors were bad, rough 
and full of wide cracks. These collected quantities of 
dust which came forth in clouds at each sweeping. The 
janitor was aggravating the trouble by dry-sweeping the 
halls during school hours, and filling all the classrooms 
with fine dust. In the mornings before the opening of 
school he stirred up fresh dust in every room by going 
over the desks with a feather duster. 

Comfortable and proper seating for the children is an 
important item among the hygienic arrangements of a 
school. It is a necessity of every school which keeps 



SANITARY INSPECTION 37 

up the use of the old-fashioned desk that adjustable 
desks be provided for the exceptional children who are 
present in every class. We found no adjustable desks in 
the Madison school, but we did find tall boys and girls 
doubled up in little seats, and little children with shoul- 
ders and arms uncomfortably propped up by desks too 
high, and with legs dangling from high seats all day. 

Mr. Ross. — What do you mean by your reference to 
the old-fashioned desk? How can school children get 
along without desks? 

Mr. Martin. — By having light movable tables and 
chairs. This arrangement, in the primary rooms at least, 
has every advantage over the regimental rows of desks 
which have always been a notable hindrance to the clean- 
liness of schoolrooms as well as to the comfort and free- 
dom of the children. It is hardly possible to keep a 
schoolroom floor clean around the legs of stationary 
desks, which collect dust and germs in every crack and 
corner; and it is even less possible for children to have 
any natural physical or social life in a room which is so 
filled with furniture that they cannot exercise freely or 
occasionally form little groups. Tables and chairs that 
can easily be moved aside at any time meet the triple 
need of a schoolroom — sanitary, hygienic, and social. 

I could easily go into greater detail in my report, but 
the items I have mentioned cover in a general way the 
extent of our investigation. Our findings I think prove 
beyond a question Mr. Young's contention, uttered at 
our first meeting, that the schools are damaging the 
health of our children. 

Mr. Ross. — The conditions you report, Mr. Martin, 
are scandalous. I should like to know who is to blame 
for them. 

Mr. Martin. — I am to blame, Mr, Ross, and you are 



38 



HEALTH AND THE SCHOOL 



to blame, and every one in this room is to blame, as well 
as every citizen in this town. The Madison school is a 
public school. The public is responsible for it. If the 
school board has failed, as it certainly has, to maintain 
a decent school building, why haven't the 600 parents 




LEGAL REGULATION OF SCHOOLHOUSE CONSTRUCTION (1912). 

The states in white have complete regulation; those in light shading 
moderate regulation; those in dark shading deficient regula- 
tion; those in black have no regulation at all. [From Russell 
Sage Foundation]. 

who are interested in it insisted on proper arrangements 
for their children? Why have the doctors in this town, 
who are supposed to guard our health, allowed these dis- 
ease-breeding conditions to continue? None of us can 
escape the blame, which is written large in our deficient 
laws regulating schoolhouse construction. 

Miss Parsons. — Now, however, that the light has been 
turned on, Mr. Martin, may we not hope to have school 
conditions improved? When people really find out how 



SANITARY INSPECTION 39 

bad things are, they are usually eager to do all they can 
to right them. 

Mr. Martin. — We have found that to be true, Miss 
Parsons, and I am glad to report that radical improve- 
ments have already taken place in the Madison school. 
When the principal and I realized what the sanitary 
conditions and practices in the school really were, we 
could not rest till we got some changes started. 

The principal organized his teachers into a kind of 
sanitary vigilance committee. He persuaded a children's 
specialist to show the teachers how to give simple eye and 
ear tests, and how to seat the children according to the 
results of these tests ; also how to avoid eye-strain from 
unchanging light conditions by simply having each pupil 
sit in different parts of the room every day. This physi- 
cian also taught the teachers how to adjust seats and 
desks to the size of the children, for I am happy to say 
that, though chairs and tables are still out of our reach, 
we have finally persuaded the school board to place 8 or 
10 adjustable seats and desks in each room. 

After we had the teachers enlisted, we attacked the 
building. The most desirable treatment for that, obvi- 
ously, was to tear it down and build a new school house 
on a new site. That being out of the question, we satis- 
fied ourselves with accomplishing the following results : 

Grounds. — We have contracted to have the school yard 
drained, during the long vacation, and part of it treated 
with a durable and elastic dressing especially adapted 
for playgrounds.* The section now covered with lawn 
and shrubbery will be used for school gardens. 

Ventilation. — i. The fire at the bottom of the aspirat- 

* For description of surface dressing, see The Reorganised 
School Playground. United States Bureau of Education, Bul- 
letin No. 16, 1912. 



40 



HEALTH AND THE SCHOOL 



ing chimney has been started and ordered to be kept 
going whenever windows cannot be kept well open. 

2. The janitor and teachers are instructed to have the 
outlet flues always open and clear. 

3. A complete change of air is secured in each room 
at the end of every hour by opening all windows for a 
few moments. 

4. A number of recitations are held daily as fresh- 
air classes, and a fresh-air room has been inaugurated, 
to which anemic children from other schools are ad- 
mitted. 

5. Apparatus for humidifying air has been installed 
at moderate expense. 




LETTING IN THE AIR AND SUNSHINE. 



Almost any old building can be transformed into an open air school 
simply by removing part of its wall. 



SANITARY INSPECTION 



41 



Lighting. — i. The trees in the yard have been 
trimmed. 

2. The windows are kept thoroughly clean. 

3. No plants are allowed to interfere with the illumi- 
nation. 

4. The window shades are all in working order and 
intelligently manipulated by the teachers. 

5. The children are seated, with reference to simple 
eye tests, in such a way as to secure their greatest com- 
fort, those with defective vision next the windows, those 
with myopic or short-sighted eyes in the front seats. 

6. The seats that were wrongly placed with respect to 
the light have been set so that the light falls from the 
left. 

Sanitary Appliances and Practices. — i. The janitor is 
now required to wash closets and urinals daily with brush 
and hot water, and at least twice a week with a germi- 
cide. 




SANITARY DRINKING FOUNTAINS. 



Fountain heads can be installed at small expense in place of the 
old-fashioned faucets and chained cups. 



2. Enough artificial light has been installed in each 
toilet room to allow the cleanliness of the appliances to 
be inspected. 



42 HEALTH AND THE SCHOOL 

3. It is planned during the short vacation, to install 
systems of heating and ventilating in the toilet rooms. 
Warm air will be used for heating, as this will assist the 
ventilation. For mild weather a number of inexpensive 
electric fans will be provided. 

4. The common drinking cup has been abolished, and 
fountain jets put in its place. 

5. For the common towel inexpensive Japanese paper 
towels have been substituted. 

6. The floors, in the vacation, will be cleaned, scraped, 
filled, finished, and waxed. In the meantime the janitor 
has been prohibited from doing any dry sweeping 
or feather dusting, or from sweeping any floor dur- 
ing school hours. He is required to have the whole 
building dusted with damp cloths every day before the 
morning session, and to have all the floors scrubbed on 
Saturday. 

7. Adjustable desks have been assigned to all the chil- 
dren who needed them, and it is now possible for every 
child in the school to work with his arms resting in com- 
fortable positions, and with his two feet set squarely on 
the floor. 

Finally, the principal makes a careful and thorough 
tour of inspection throughout the building each day, to 
see that the daily sanitary routine is maintained in all 
these essential particulars. 

The greatest result of our two months' work, however, 
has not been the partial rehabilitation of the miserable 
old school building. It has been in the improvement of 
the school children themselves. Miss Parsons and her 
committee may justly claim to find results from remov- 
ing the defects of the Washington school children ; but 
it is evident that removing merely the defective condi- 
tions in the Madison school has gone far toward trans- 



SANITARY INSPECTION 43 

forming its children. Thanks to the fresh, clean, and 
sufficiently moist air that the pupils are now breathing, 
and the better light provided for their eyes, the principal 
is able to report marked increase in energy and success 
in school work, and problems of discipline reduced about 
75 per cent. 

Mr. Ross. — We owe Mr. Martin a vote of thanks on 
behalf of our club, and on behalf of the whole town, 
for the valuable pioneer work he has done in our school 
sanitation. His work has shown sanitation to be a very 
fundamental department of school administration. I for 
one should like to know much more about it. May I 
not ask Mr. Martin, in concluding his report, to give us 
a brief summary of the general standards to be attained 
in school sanitation, together with a few suggestions as 
to the best methods of attaining them? 

Mr. Martin. — In our limited time I can hope only to 
give the most condensed outline, but it will doubtless 
clear up the subject in our minds to review systemati- 
cally, though briefly, the general principles touched on 
in the report just described. 

SITE 

The site of the schoolhouse should be chosen ivith 
a view to obtaining pure, dry air, good light, reasonable 
quiet, and sufficient outdoor play space. It should, there- 
fore, be on "dry, porous ground, well-drained, free on 
all sides, distant from any buildings, far from factories, 
offensive trade establishments, markets, boiler shops, 
saloons, and elevated railroads, far from anything creat- 
ing noise, smoke, smell, gases, or fumes." 

Mrs. Ross. — May I ask what is regarded as sufficient 
play space? 



44 HEALTH AND THE SCHOOL 

Mr. Martin. — The standard is necessarily a flexible 
one. London, the most congested city in the world, 
allows each child 30 square feet of school yard. That 
permits each child to do little more than swing his arms 
about him. Many of our large cities do not observe even 
this standard. In one of our greatest cities 168 of the 
schools fall below the 30-foot limit, one school in the 
list having only 1.3 1 feet per child. At least 145 square 
feet per child, or an acre for 300 children, is required 
for active play. Even this apparently liberal allotment 
falls far short of the need of active boys, who cannot 
play their favorite running games if more than 70 are 
allowed on one acre. 



CONSTRUCTION 

The main concerns in the construction of a building 
are: safety, light, heating, ventilation, cleanliness, and 
convenience. While safety and sanitation are quite dis- 
tinct items and are, indeed, conducted by separate mu- 
nicipal departments, school authorities should keep as 
close watch on arrangements for safety, especially those 
bearing on fire prevention, as on those for sanitation. 
Wood should be avoided as a material for construction, 
except in the smallest rural schools. The height of the 
building should never exceed five stories, and wide stair- 
cases — 44 inches for two files — should make it possible 
for children to reach the different floors comfortably and 
rapidly, without the use of elevators. Ample fire-escapes 
should also be provided, though these should never be 
regarded as the main dependence of the children against 
the danger of fire. Fire prevention, not fire escape, is 
the ideal of the modern school, which should be equipped 
with fire walls and doors to prevent the spread of a fire 



SANITARY INSPECTION 45 

that has started; wire glass to prevent the breaking- in 
of windows by flames, and automatic sprinklers in places 
where fire is likely to start. For the sake of insuring 
not only fire security, but quiet, cleanliness, and whole- 
some air ; "the walls, floors, ceilings, and partitions 
should be sound, damp, fire, vermin, and dustproof. The 
junctions of ceilings and floors with walls should be 
concave, and all projections, moldings, etc., where dirt 
and dust may lodge should be eliminated whenever pos- 
sible." * 

Ample provision should be made for dressing-rooms, 
library, study rooms, auditorium, bathroom, teachers' 
room, and nurse's room. 

The further items of construction afifecting heat, ven- 
tilation, light, and cleanliness we will take up separately 
under those heads. 

HEATING 

The heating system should provide a temperature 
which insures a maximum of comfort and energy to the 
pupils. Such a temperature, when air is fresh and suffi- 
ciently moist, is reached, for ordinary school work, at 
the comparatively low point of 65 degrees. The perfec- 
tion of modern heating systems makes the meeting of 
this temperature requirement an easy matter. It is in 
relation to ventilation that the heating system becomes 
an item of very critical determination. 

VENTILATION 

A satisfactory ventilation system provides for the in- 
troduction and adequate circulation of good clean air in 
sufficient amount for all the individuals who occupy a 

* Hygiene and Public Health. Price. 
5 



46 HEALTH AND THE SCHOOL 

school. The present accepted standards of good school- 
room air are : CO2 content, 4 to 10 parts in 10,000 ; hu- 
midity, 40 to 60 per cent. ; temperature, 65 to 68 degrees ; 
amount, 1,200 to 1,800 feet per pupil per hour; cleanli- 
ness, freedom from dust, smoke, poisonous gases and 
odors. 

As I stated before, the proportion of CO2 that can 
exist in air without rendering it harmful is a matter of 
present controversy. Recent careful experiments have 
indicated the surprising fact that the COo content in air, 
instead of reaching the maximum for health at 10 parts, 
can rise as high as 150 parts in 10,000 and even higher 
without resulting in physical discomfort or disturbance, 
provided that the air is circulating freely and does not 
become too hot or moist. 

Mr. Ross. — Then what value had the CO2 test that 
was applied in the Madison school? 

Mr. Martin. — As a test for the contamination of the 
air alone it had little significance; as an indication of 
the stagnation of the air it was important. Stagnant 
air has been shown to be uncomfortable and unwhole- 
some, even when it is pure. 

Mr. Ross. — I can't see how pure air can be either un- 
wholesome or uncomfortable. 

Mr. Martin. — We have all experienced the condition 
on a sultry, summer day, when no breath of air was stir- 
ring. The outdoor air, though pure, was just as bad 
as the indoor air. The lack of a breeze was the whole 
trouble. The body envelope of air which immediately 
surrounds the body, becomes overcharged with heat and 
moisture, unless it is being constantly changed by a mod- 
erate current of air. A stagnant condition of the air, 
whether outdoors or indoors, brings on the characteristic 
symptoms that are caused by bad ventilation. These 



SANITARY INSPECTION 47 

seem beyond a doubt to be due to the discomfort of the 
skin and possibly the lungs, but not to inhaled poison.* 

Mr. Ross. — If the skin is all that is to be considered 
in ventilation, why not simplify matters by installing a 
lot of electric fans in schoolrooms, and letting the elabo- 
rate contrivances go? 

Mr. Martin. — To add electric fans to the schoolroom 
equipment would undoubtedly contribute greatly to the 
comfort of pupils, if the fans were so placed as to avoid 
strong drafts on anyone. I have, in fact, tried the effi- 
cacy of the electric fan in "freshening" the air in a 
room. My stenographer had decided she could no longer 
endure the oppressive air of my office. Daily headache 
and lassitude, she felt, would compel her to give up her 
work. I determined to try the fan. From the first day 
it was installed, though no other change in the ventila- 
tion was made, the stenographer's bad symptoms disap- 
peared, and now, after several months, she is comfor- 
table and full of energy. 

To substitute fans, however, for the standard methods 
of ventilation would be an unwarranted step in the pres- 
ent experimental stage of the subject. Recent experi- 
ments in the Harvard Medical School indicate strongly 
that there are actual poisonous substances in expired 
air. The combined plenum and vacuum methods for 
large buildings, gravity and exhaust system for smaller 
buildings, and the jacketed stoves with an air flue from 
outside and a vent, for one-room schools, must be re- 
garded as the approved methods until practical devices 
have been demonstrated which meet the condition bet- 
ter than do the best ones now in vogue. 

It must be remembered that, no matter how perfect 
a ventilating system may be, it is never the substitute for 

* The Heating and Ventilating Magazine, February, 191 1. 



48 HEALTH AND THE SCHOOL 

direct outer air that its advocates often claim. If win- 
dows must be closed to assist the operation of a ventilat- 
ing system, these should be opened top and bottom at 
least once an hour to secure a thorough blowing out of 
the schoolroom. A sudden drop in temperature is no 
obstacle to the plan. Children are refreshed by cold that 
does not last long enough really to chill them. 

Two more points must be emphasized with respect to 
air introduced into schoolrooms. It must be clean, and 
it must not be overheated or "baked." Outer air that 
is charged with dust should be filtered or washed. Pass- 
ing air through a wet gauze screen at the opening of 
the fresh-air flue is a simple and fairly effective way of 
cleansing it. Air used for warming as well as ventilat- 
ing purposes should never be heated to over loo degrees, 
as a higher temperature makes it injurious in several 
ways. Carbon monoxide, a deadly poison, penetrates red- 
hot iron and enters the air chamber of an overheated 
furnace. Burning particles of iron and dust contribute 
disagreeable odors, and other factors not yet plain cause 
baked air to be harmful. Consequently, hot-air systems 
not reinforced by direct radiation should be confined to 
climates that do not require forced heating. 

The best standards for good air we may now sum up 
in a word. Keep air clean ; keep it cool ; keep it moist ; 
keep it moving. 

LIGHTING 

In the lighting of a schoolhouse the aim is twofold: 
to secure as much natural sanitation through sunlight 
as possible, and to provide enough light to make all eye 
work comfortable and safe. Every room should be so 
placed as to allow the sun to enter at some time during 



SANITARY INSPECTION 49 

the day, a southeast exposure being the most desirable 
for this purpose. The main hght should come from the 
left. The proportion of the area of windows to floor 
space should not be less than i to 5. Windows should 
have square corners, with tops not more than 6 inches 
from the ceiling, and bottoms not more than 3 feet 6 
inches from the floor. When outside light is obstructed 
window glass should be ribbed or prismed. Windows 
should be fitted with two opaque shades, rolling respec- 
tively up and down from the middle. Ceilings should 
be white or light bufif, and the walls light green or buff. 
Windows should be kept clean and unobstructed. For 
artificial illumination electric light is best. 

PLUMBING AND DISPOSAL OF WASTE 

The purpose of plumbing and the various methods of 
waste disposal is cleanliness, through the supply of water 
for cleansing purposes and the removal of offensiz'e and 
dangerous matter. "There should be ample provision 
for washrooms, basins, shower baths, urinals, water- 
closets, all situated conveniently in well-lighted, heated, 
and ventilated apartments ; the fixtures made of porcelain 
or enameled iron, the floors, walls, and ceilings con- 
structed of stone, tile, or pressed glass. Water-closets 
should be provided with automatic flush apparatus." * 
When plumbing cannot be installed and no running water 
is at hand, the dry earth closet is the most sanitary toilet 
arrangement. This must receive constant, intelligent 
care, and should be situated not less than 40 feet from 
the schoolhouse. When running water is available the 
septic tank system is a safe and inexpensive method of 
waste disposal. 

* Hygiene and Public Health. Price- 



50 



HEALTH AND THE SCHOOL 

DRINKING FACILITIES 



Wholesome drinking water should be provided to 
school children by methods which do not permit the 
spread of contagion. Unless drinking- water comes from 
an artesian or other thoroughly certified well, it should 

invariably be fil- 
tered. If the pub- 
lic water works 
do not provide fil- 
tration, the schools 
should do this by 
means of properly 
adjusted and fre- 
quently cleaned 
filters. In case of 
demonstrated con- 
tamination, water 
should be boiled 

COVERED CAN AND INDIVIDUAL CUPS. ^Q miuutCS The 

Sanitary substitutes for the disease-breeding rnmmon drinkinP" 
open water bucket and common cup. , ° 

cup must give 

way to the drinking fountain, when there is running 
water; or, when water is restricted, to sanitary paper 
cups or individual cups under the care of the teacher. 
Water receptacles should be kept closely covered to pre- 
vent the contamination sure to result from the use of open 
pails. 

FURNITURE 

School furniture shoidd minister to the ease and com- 
fort of school work, and be so chosen and cared for that 
it cannot produce injury to the pupils through contagion 
or strain. Desks and seats and tables should be care- 




SANITARY INSPECTION 51 

fully adjusted to pupils. They should not be perma- 
nently attached to the floor. Blackboards should be of 
slate, and placed where they can easily be seen by all 
pupils. The common towel should be replaced by the 
cheap paper towel which is destroyed after being used 
once. Pictures, charts, globes, models, and instruments 
should be coated with varnish, and should be smooth and 
easily cleaned. Pens, pencils, and books should be used 
as individual property and disinfected before going into 
the possession of other pupils. 

The last-named articles, and many others like them, 
while they may be regarded as school furniture, are 
really materials of instruction, and their control, except 
as regards their sanitary cleanliness, falls more properly 
under the hygienic regulation of school activities. Such 
regulation is a much-needed branch of health supervi- 
sion. Until the time comes when school activities are 
regulated hygienically, which is far from the case at 
present, sanitary authorities must do what they can to 
secure a wholesome school equipment. It is altogether 
likely in the future, however, that a department for the 
regulation of school activities will take over the chief 
responsibility for school furnishing, as these present 
many problems quite distinct from those of ordinary 
sanitary requirements. 

CLEANING 

Schools are cleaned for the purpose of keeping them 
free from dust, germs, refuse, and bad odors. Dust is 
the main point of attack, and prevention of dust is the 
first move to make. The building itself and the articles 
in its equipment, as we have seen, should all be devised 
so as to catch and hold the least possible dust. Dusty 



52 HEALTH AND THE SCHOOL 

outer air, we have already stated, should be cleansed 
before it is introduced into the ventilating flues. 

The most effective method of all for excluding dust, 
dirt, and germs from schoolrooms, though as yet it is 
least recognized, is to prevent children from distribut- 
ing the mud and filth of the streets over schoolroom 
floors by means of their shoes. The Japanese people, 
who have adopted our best sanitary standards and re- 
tained the best of their own, do not permit street foot- 
wear to be worn within their buildings even when these 
buildings are on European models and their occupants 
wear European dress. As a consequence of this rule, 
the floors of houses, hospitals, and schools, when not 
covered with matting, present the appearance of polished 
table tops. 

Mrs. Ross. — What an enviable condition! Surely 
dirty shoes are the chief source of dust in our schools 
and pubHc buildings, not to say private dwellings, but 
how could you ever arrange to have 500 children take 
off their shoes before entering a school building? 

Mr. Martin. — The Japanese provide a roomy vesti- 
bule where this is done. We could easily solve the diffi- 
culty if we became convinced of the sanitary importance 
of such an arrangement. 

In the meantime the warfare against dirt, both pre- 
ventable and unpreventable, must go on vigorously and 
continuously. The first requirement in sanitary cleaning 
is to avoid the raising of dust. The vacuum cleaner 
answers this requirement most satisfactorily. Sweeping 
and "dusting" can be made fairly dustless operations, 
however, by the use of wet sawdust scattered over floors 
for sweeping, and damp cloths for use in wiping furni- 
ture and floors. These should be wiped up every day 
when rooms are in use. A disinfectant should be used 



SANITARY INSPECTION 53 

not less than once a week. Strong soapsuds alone make 
an excellent disinfectant. 

Floors, to be kept clean, must present smooth surfaces ; 
if they are made of soft wood they should be treated 
with hardening preparations. Oil as a floor dressing 
does not deserve the vogue into which it has recently 
sprung, as, instead of eliminating dirt, it binds the dust 
on the floor, where it sticks. In fact wood, unless 
polished and waxed, does not make the most sanitary 
floor for schools, and we cannot hope to have really first- 
class wooden floors until we stop the habit of grinding 
dirt into them with our shoes. Many English schools 
have floors of small stone blocks set in cement, which 
are easy to scrub, comfortable, and soundproof. 

Window Cleaning. — Window cleaning, as we have 
seen, is of great importance. The frequency with which 
this is needed varies much, according to location, cli- 
mate, and season, but a schedule should be followed 
which is carefully regulated with a view to keeping the 
glass constantly clear. 

This finishes the list of general items to be considered 
in the sanitation of school buildings. Two main pur- 
poses are back of the entire program, determining every 
item on the list. They are comfort and cleanliness. 

Mr. Young. — After hearing this excellent summary of 
modern sanitary standards and realizing the distance 
-which most of our schools must travel to reach them, 
I am tempted to paraphrase Portia's words — If to do 
were as easy as to know what were good to do, chapels 
had been churches and poor men's cottages sanitary 
schoolhouses. 

Miss Parsons. — And why shouldn't they be? The 
twentieth century man does not spend his life in wistful 
desire. To know what were good to do is the modern 



54 HEALTH AND THE SCHOOL 

signal for doing it. As soon as the American people 
find out that they need sanitary schoolhouses they will 
get them. Two states — Virginia and Wisconsin — are 
now conducting state-wide campaigns of sanitary edu- 
cation through their Universities ; and Wisconsin is sub- 
sidizing her country schools for the purpose of equipping 
buildings with proper heating, ventilating and sanitary 
devices. 

Will it be long, do you think, before the reproach of 
sending children to unsanitary schoolhouses will be lifted 
from every state in the Union? 



Suggested Reading 

American School Hygiene Association. Proceed- 
ings OF THE Second Congress. Schoolhouse Con- 
struction as Affecting the Health and Safety of 
Children. 

Proceedings of the Third Congress. An Inquiry 
Into the Problem of Desks for Children. 
Proceedings of the Fifth Congress. Proper Sani- 
tation of the Schoolroom. 

Ayres. Open-air Schools. 

Denison. Helping School Children, pp. 145-160. 

Search. The Ideal School, Chapter V. 

Shaw. School Hygiene, Chapters I-VH. 

United States Bureau of Education. American 
Schoolhouses. 
Rural Schoolhouses. 



IV 

A SCHOOL CHILD'S DAY 

Mr. Young. — In our last two meetings we have been 
shocked to hear that our town is every day sending 
thousands of physically defective children to spend five 
hours in a dozen school buildings that are violating many 
of the simplest rules of sanitation. 

What do these defective children do when they get 
to the unsanitary buildings? How do they spend their 
time? Our school children's daily programs still wait 
to be scrutinized. Mrs. Ross will guide us in this task. 

Mrs. Ross. — The task would be a most ungrateful one 
if it were not a necessary step toward an improved sched- 
ule for the children. We cannot, of course, hope for the 
immediate correction of all the abuses that are going on 
in our schools. ]\Iany of these are in accordance with 
general school practice, and must wait until an enlight- 
ened public sentiment puts a stop to them. It will be a 
great advance for us, however, to understand the abuses 
clearly. 

Mr. Martin. — It seems to me that the word "abuses" 
is remarkably strong language to apply to the efforts of 
the public schools, the most altruistic of all our institu- 
tions. 

Mrs. Ross. — I can think of no other word that de- 
scribes so accurately certain things that are taking place 
in our schools, for the reason that many of our edu- 
cational leaders have not yet learned to gauge school 

55 



56 HEALTH AND THE SCHOOL 

requirements according to such non-academic matters as 
the capacities of httle children's eyes and stomachs and 
nerves. 

Our schools at present set a far higher value upon 
a child's ability to pass a set examination than upon his 
ability to digest a dinner. That a school curriculum 
should be arranged with reference to such arbitrary tests 
as examinations, or to some possible future needs of 
grown-up citizens, and not first and always with refer- 
ence to what young eyes and stomachs and nerves will 
not only endure but thrive under, seems to me the most 
comic anomaly of all our highly intelligent modern life. 

Like all things humorous, the school comedy has its 
tragic aspect. This appears in the spent eyes, ruined 
stomachs, and shattered nerves that often pay for the 
successful examinations and the preparation for future 
citizenship. 

Mr. Martin. — Are we guilty of bringing such disas- 
ters upon our school children here? 

Mrs. Ross. — Guilty is the word, Mr. Martin, though 
our school authorities can shift part of the responsibility 
to other shoulders. The curriculum of the high school, 
for instance, is largely dictated by the colleges and their 
arbitrary entrance requirements ; the work in the ele- 
mentary schools, in turn, is determined by the high 
school entrance requirements and the state examinations. 
Our schools devise their own weekly and daily programs, 
to be sure, but these must be in strict accord with college 
and state demands. 

Before going into a detailed criticism of our school 
program I wish to make it clear that my report is not 
based upon opinion but upon evidence. The criticisms 
and suggestions advanced are made entirely with refer- 
ence to a few scientifically established facts regarding the 



A SCHOOL CHILD'S DAY 57 

endurance, liability to fatigue, and the recuperative pow- 
ers of children. The facts so far established are un- 
fortunately few and little known, but they have the im- 
mense advantage of being facts, and consequently out- 
weigh the total enormous output of professional opinion 
up to date. Until about 1910 one school superintendent's 
guess was as good as another's in answer to such ques- 
tions as these : How many hours of purely mental work 
in a day can children of certain ages stand? How much 
exacting eye work is it safe to require? What is the 
best number of pupils for classes of various kinds? 
What subjects are most fatiguing? What is the result 
in fatigue or stimulation of formal physical exercise? 
Of what lengths should recitations be made? How fre- 
quent and how long should recesses and vacations be? 

For many years the discussion of these questions and 
many others like them has produced great heat and little 
light. Discussion does not develop physiological law. 
There is only one method that can show just how school 
work affects children. This is psychological and physio- 
logical investigation which is based upon a thorough 
analysis of school conditions, and extensive, accurate 
measurements of the results of these conditions on school 
children. 

Practical work of this sort is new. Many problems 
of the school program still remain to be solved, but the 
few results thus far established are sound, and they are 
sufficiently revolutionary to keep us well occupied for a 
time in applying them. With uniform consistency the 
facts that have been worked out show (a) that our 
schools are requiring far more book work, that is, work 
unconnected with muscular activity, than children can 
profit by or even safely endure; (b) that they are giv- 
ing too short and infrequent recesses between hours of 



58 HEALTH AND THE SCHOOL 

study, including an insufficient pause for the noon meal ; 
(c) that their systems of home study, examination, and 
competition impose on the children dangerous strains 
which teachers have no means of measuring or regulat- 
ing. 

Mr. Martin. — I should be much interested to know 
how the scientists are able to arrive at these sweeping 
conclusions. 

Mrs. Ross. — They have done so by the study and 
comparison of records of thousands of children. They 
have measured accurately the work accomplished and 
the fatigue incurred under various sets of conditions, 
such as short hours and long hours, with and without in- 
terposed recreation periods, at school and at home, be- 
fore and after heavy meals, before and after vigorous 
exercise, in large classes and small classes, when the 
subject was stimulating and when it was dull. 

Mr. Martin. — Results based on such thorough work 
as you describe evidently admit of no contradiction, but 
I should like to know, nevertheless, just how it is pos- 
sible to measure fatigue. Do the investigators depend 
on the children to say when they are tired? 

Mrs. Ross. — Not by any means. Children who are 
not in the least fatigued often declare they are weary, 
and no less frequently children on the edge of nervous 
exhaustion are keen for more work. Objective tests 
are the only reliable ones for determining fatigue. Those 
that have been found most accurate are measuring the 
changes in the action of the muscles of accommodation 
of the eye, the varying sensitiveness of the nerves of 
touch, and the speed and accuracy of performing cer- 
tain mental and muscular processes, such as the written 
addition of numbers and the copying of letters. There 
are also general symptoms that indicate chronic fatigue. 



A SCHOOL CHILD'S DAY 59 

These are uneasy and insufficient sleep, loss of appetite 
and weight, lack of mental concentration, restlessness, 
irritability, and languor. These symptoms invariably ap- 
pear among a large proportion of children during term 
examinations and prize contests, which is quite enough 
to condemn these practices. 

Now let us examine in detail the amount and kind 
of work our own schools are requiring, and compare 
these requirements with the soundest modern standards. 

We find that our primary grades are spending four- 
fifths of the school session in formal work, that is, four 
out of five hours are spent in book study and arbitrary 
drill in reading, writing, arithmetic, and geography. 
This arrangement is in direct opposition to the best 
school usage, which provides that at least half the time 
in the primary grades be devoted to physical activity 
of various kinds : singing, educational games and dances, 
and constructive work, such as weaving, sewing, cutting, 
building, modeling, and gardening; and that the remain- 
ing half of the session be spent in intellectual work 
which requires a minimum of fine nervous and muscular 
adjustment for eye or hand. During this time subjects 
in history, geography, and science may be presented 
through stories, by pictures (lantern pictures if possible), 
and by various other materials ; and these demonstrations 
may be made the basis for discussion, description, and 
reproduction in speech, dramatic representation, construc- 
tive activity, and, to a limited extent, in writing and 
drawing. Such a program allows little more than an 
hour a day for drill in reading, writing, and arithmetic, 
but this brief hour is spent in eager, intense work, which 
accomplishes as much as the three or four unrelieved 
hours that our schools ordinarily require. 

Mr. Young. — This program allows for a very limited 



6o HEALTH AND THE SCHOOL 

amount of eye work. Has it been determined just how 
much of it primary children can endure? 

Mrs. Ross. — The question has not yet been completely 
determined, but it has been very thoroughly demon- 
strated that they cannot safely use their eyes the number 
of hours we now require them to do so, and it is equally 
evident that one hour, distributed through the day, does 
the average child no harm. The varying capacities of 
individual children must, of course, be taken into account 
in considering any general rule. 

Mr. Martin. — Is such an ideal program as you de- 
scribe in actual operation in any primary school? 

Mrs. Ross. — Such programs are being followed in 
several of our leading schools with convincing results; 
conspicuous examples being the Horace Mann School 
in New York, the University Elementary School and 
the Francis W. Parker School in Chicago. 

Mr. Young. — Such a holiday atmosphere as you ad- 
vocate for the primary grades must, of course, give way 
to sterner methods in the grammar grades and high 
schools. How much purely mental work is it con- 
sidered desirable to impose in these years? 

Mrs. Ross. — The capacity for such work increases 
rapidly in children who are intellectually gifted, but 
these w^e must remember are only a very small propor- 
tion of our children. The great majority never develop 
the power of sustained intellectual work, and are forced 
to protect themselves against the fatiguing effort of do- 
ing it by sitting unresponsive during classes, or leaving 
school. By the 6th grade the children should be sorted 
out according to their aptitudes, and the "book-minded" 
ones given two to three hours a day of purely intel- 
lectual work, the others not much more than half that 
time. In the high schools intellectual work for those 




THERE S NO FUN LIKE WORK. 



These New York school children bring unbounded energy and per- 
severance to tasks which are adapted to their capacities and 
needs. 



Mi 








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WHAT ARK TXIKV RAISING? 



Active minds and vigorous bodies are conspicuous items in the crop 
reports from the boys' gardens in Dayton, Ohio. 



A SCHOOL CHILD'S DAY 6i 

adapted to it can be carried on three or four hours a day. 

A very successful attempt to adapt the work of the 
three upper elementary grades to the aptitudes of pupils 
has lately been carried out in some of the Chicago ele- 
mentary schools. The motor type of children who have 
been given hand work for half the school day, and book 
work for the other half have developed ability hardly 
before suspected. It is not an uncommon thing now for 
nine out of ten children in a class thus trained to enter the 
technical high school, though they come from elementary 
schools which, before this change in curriculum took 
place, sent almost none of their children to high schools. 

The schedule, however, for both elementary and high 
schools is not to be considered as hard and fast. There 
are certain ages when tendency to fatigue is especially 
pronounced, and the school requirements must take this 
into consideration. At the age of eight, for instance, 
most children show a distinct decline in nervous endur- 
ance, as a result of the double strain of second dentition 
and the unusually rapid growth which sets in at this 
year. Their tasks should accordingly be no heavier than 
the tasks of six-year-olds. 

Five or six years after this early nervous check comes 
the period of puberty, which invariably makes unusual 
demands on the nervous systems of both boys and girls, 
and greatly increases their tendency to fatigue. The 
school requirements should be lightly and flexibly ad- 
justed during this critical period, which with girls ar- 
rives between the thirteenth and the sixteenth years, 
and with boys between the fourteenth and the seven- 
teenth. 

The fact that boys and girls reach sexual maturity 
at different ages, and accordingly need their school work 
lightened at different times, constitutes a rather forceful 
6 



62 HEALTH AND THE SCHOOL 

argument for educating the two sexes separately from 
the thirteenth to the seventeenth years. 

Mr. Young. — I should like to hear how the total num- 
ber of school hours which you have indicated as desir- 
able should be divided. Have any general standards 
been established for length of lessons and recreation 
pauses in elementary and high schools? 

Mrs. Ross. — Yes, and these vary widely from com- 
mon practice. The German scholars with their pains- 
taking thoroughness have worked out the pauses neces- 
sary for a combination of maximum efficiency and min- 
imum fatigue. For the lower primary grades purely in- 
tellectual work should be limited to fifteen-minute pe- 
riods, and a pause for rest and informal relaxation should 
follow every half hour of such work, which should then 
be succeeded by hand work or directed games. In the 
upper primary and elementary grades classes should 
not be held longer than half an hour, and a recess from 
ten to twenty minutes in length should be granted once 
an hour, the recess period being lengthened as the school 
session proceeds and the children's tendency to fatigue 
increases. This recreation schedule applies with equal 
urgency to high school work, though recitations there 
can be extended to advantage to forty or fifty minutes 
if the classes are large, that is, numbering forty or more. 
If classes are smaller the length of recitation should be 
proportionately shortened, as fatigue develops more 
quickly in small classes than in large ones, owing to the 
closer attention they demand. Shortening the time for 
small classes has its obvious economic advantage also, 
for a given amount of work can be covered in a 
shorter time in a small class than in a large one, and 
the energy of the teacher spared as well as that of the 
children. 



A SCHOOL CHILD'S DAY 63 

Mr. Young. — I suppose some of the rest periods may 
well be taken for gymnastic exercises. 

Mrs. Ross. — That is a thing very commonly done, but 
the practice is wrong. The recesses cease to be rest 
periods if they are taken up with gymnastics. Formal 
gymnastics are proven to be fully as fatiguing to brain 
and body as the most exhausting of all studies, 
arithmetic. They are doubtless necessary for the 
health of school children if the schools lack space and 
equipment for active games and play, but they must 
rank as one of the fatiguing though desirable school 
exercises and not masquerade as either rest or recrea- 
tion. 

Mr. Martin. — In connection with the matter of rest 
pauses, I have a grievance against our present school 
schedule. Mrs. Ross hinted at the beginning of her re- 
port that the noon intermission was not long enough. 
This period is certainly not a time of rest in our family, 
as it undoubtedly should be. The children hurry home, 
bolt their dinner, and are ofif again in a rush for their 
two afternoon hours of school work. 

Mr? Ross. — You have brought up one of the most 
radical of all the changes which our schools ought to 
make. The present noon pause of an hour and a half 
is too short by at least an hour. The noon meal for 
children should be the heartiest in the day, and should 
be well digested before further work is demanded. It 
should be leisurely, and followed for at least half an 
hour by actual rest or the lightest occupations. Exact- 
ing school work should not be resumed for at least two 
hours after the noon meal. By that time children as 
well as teachers are able to do as exacting work as in 
the morning hours. 

Mr. Young. — So long a noon intermission would re- 



64 HEALTH AND THE SCHOOL 

quire the afternoon session to extend till 4.30 or 5 o'clock. 
Do you think parents would agree to that? 

Mrs. Ross. — German parents do. Those hours are in 
common favor in Germany. 

Mr. Martin. — But such late hours would make it 
harder than ever for the children to do their home study. 

Mrs. Ross. — Why should they do any home study? 

Mr. Young. — I doubt whether a schedule can be de- 
vised to avoid it. 

Mrs. Ross. — I agree with you, if we are to leave the 
school requirements and the length of the school session 
just as they are. One or both of these factors in the 
school schedule can be changed, however, and will be 
changed as soon as we wake up to the fact that ordinary 
"home work" for elementary school children is a bar- 
barism. 

In the first place, the home preparation of lessons is 
often a farce, being done for the edification of teachers 
by sympathetic parents. I confess my own frailty in 
this matter, as I never scruple to help my children all 
I can when I see their nerves strained by home lessons. 
My scruples develop the next day, however, when the 
children have taken their neatly done exercises to school, 
and I pause to reflect that the overworked teachers will 
use their limited time and strength to' mark me 100 in 
arithmetic. The school board would really economize 
its resources by delivering parents from the temptation 
of the "lesson graft." 

The other objections to home work have direct refer- 
ence to health, and are even more serious. In the aver- 
age home, lessons are studied immediately after supper, 
with poor light and in the midst of a sociable family. 
The direct consequences of this arrangement are indi- 
gestion, eye troubles, and general nervous strain. 



A SCHOOL CHILD'S DAY 65 

Mr. Martin. — I fear my own children are inviting 
some of these disorders, but how to prevent their doing 
it is a puzzle. 

Mrs. Ross. — Do you not sometimes question whether 
your children might not be better ofif, mentally as well 
as physically, with certain of their studies completely 
dropped ? Why do we continue to let the schools pile 
their dead languages and higher mathematics and fantas- 
tic forms of arithmetic upon the children ? The disciplin- 
ary value of these studies, the psychologists tell us, has 
been grossly over-rated. And, again, why do we not 
insist that the schools shall make their sessions long 
enough for the children to learn the lessons they are 
sent there to be taught ? We seem hardly to realize that 
we are all part owners of the public school and that our 
convictions with respect to it can shape its policy. The 
curriculum is not a changeless entity, incapable of being 
adapted to the needs of the children, for whom it exists. 
Let us have it rearranged and prolonged, if necessary, 
so as to make sure that the children shall go home 
free from care for their short evenings of social 
recreation. 

Mr. Young. — I am greatly impressed with the case 
you make out against home work. Would you try to 
abolish it for the high schools as well as for the ele- 
mentary schools? 

Mrs. Ross. — It probably cannot be altogether avoided 
there, though much of the lesson preparation could be 
done to the best advantage in the school building after 
the regular session. In cases where lessons must be 
studied at home there should be a regular home schedule 
approved by the teacher, indicating the time, place, and 
conditions under which the work is to be done. To en- 
courage work in the schools the buildings should be kept 



66 HEALTH AND THE SCHOOL 

open all day, and a certain number of teachers be in at- 
tendance to look after the needs of pupils. 

Mr. Young. — Wouldn't there be a great outcry if we 
were to keep the children in school more than the five 
hours they are already held there? 

Mrs. Ross. — There undoubtedly would, if we kept 
them doing the same formal tasks to which they are 
already giving too much time ; but not if we gave them 
a chance to play and work with their hands and make 
things, as children long to do, out of wood and cloth 
and metal and flour. 

Mr. Martin. — Are any schools actually doing this 
sort of thing? 

Mrs. Ross. — Most assuredly. In Gary, Indiana, for 
instance, where the compulsory school session is only 
a little over five hours, half to three-quarters of the 
children voluntarily spend from six to eight hours a 
day, Saturdays and vacations included, under the super- 
vision of teachers, in the schoolrooms and grounds and 
swimming pools. Of the five hours' session itself only 
one-quarter of the time is devoted to formal class work. 
The children, probably not more than 5 per cent, of 
whom are "book-minded," are getting what they want 
and need in the shops and playgrounds as well as in the 
classrooms, and are making progress that abashes the 
conventional schools. 

Mr. Young. — How much recess or play time do the 
Gary children have? 

Mrs. Ross. — One-fourth of their session is devoted to 
play, which, however, is often led to have a very close 
relation to their school work. There are certain games, 
for instance, which require a knowledge of addition, and 
these serve as a powerful stimulus to the arithmetic 
classes. 



A SCHOOL CHILD'S DAY 67 

Mr. Martin. — If the schools are to absorb so much 
of our children's time, how are we going- to squeeze 



A SCHOOL CHILD'S DAY IN GARY, INDIANA 
Note the liberal provision for directed play and hand work 



FOURTH GRADE 

8.45 Arithmetic, Geography, History 

10.15 Play and Physical Training 

11.00 Reading, Writing, Spelling, and Language 

11.45 Noon Intermission 

i.oo Nature Study, or Manual Training and Drawing 

2.30 Play and Physical Training 

3.15 Music and Literature 

4.00 Close of Day's Work 

FIFTH GRADE 

8.30 Arithmetic, Geography, History 

10.15 Manual Training, or Science 

12.00 Noon Intermission 

1.00 Reading, Writing, Spelling, and Language 

2.30 Physical Training 

3.15 Music and Drawing 

4.00 Voluntary play until 5 o'clock 



in the private lessons in music and dancing and the 
other extras? 

Mrs. Ross. — That is a rather special problem, as most 
children have neither music nor dancing lessons beyond 
what the schools provide. The question is not to be 
ignored, however, and should be frankly taken up with 
the school authorities. Parents and teachers must con- 
fer in making out the complete daily schedule, and, if it 
seems wise to make heavy demands on the children 



68 HEALTH AND THE SCHOOL 

through private instruction, the public school demands 
should be correspondingly lightened. 

Mr. Young. — I welcome as a relief from the heavy 
charges which Mrs. Ross has brought against the schools 
her reference to the responsibility of parents. Is there 
not as much juvenile fatigue induced by late evening 
hours and social thrills as by too heavy lessons? If 
parents demand that we devise hygienic school sched- 
ules, which I admit we have not yet done, they must 
heed our demand for hygienic home schedules. 

Mrs. Ross. — Nothing could be more desirable, Mr. 
Young. A child's daily program from waking to sleep- 
ing, at home and at school, should be judiciously worked 
out by teachers and parents together, and then adhered 
to, unless it is proving too fatiguing. Aside from the 
hygienic value of such an arrangement, the established 
habif of the methodical disposition of time is a priceless 
one. 

In arranging the daily program teachers and parents 
must both remember that each child has his own in- 
dividual limit of endurance, and that even this varies 
from time to time, as in the ninth year and later at 
puberty. The eight-year-olds, for instance, should be 
spared their piano lesson for two years more, unless the 
school tasks are distinctly lightened to permit of this 
special nervous tax. 

When the daily program is once agreed upon, teacher 
and parent must still be on the alert for symptoms of 
chronic fatigue, and warn each other when either sees 
them. 

Mr. Young. — Are we to understand that all fatigue 
must be eliminated from the experience of school chil- 
dren ? 

Mrs. Ross. — Not at all. Fatigue cannot be avoided 



A SCHOOL CHILD'S DAY 



69 



for children, nor is it best that it should be. Now and 
then children should be made to work a little when they 
are fatigued. They recuperate rapidly and are all the 
hardier for their exertions. This Spartan prescription 
applies only to occasional spurts, however, and should 
never become habitual. Chronic fatigue is to be avoided 
like the plague. Children's sleep should be long and 
sound, and restore their nerves completely each day. If 
the mornings find children unrefreshed there is certain 
trouble brewing. Nervous exjiaustion in any human be- 
ing is a scandalous condition. To permit a child to suf- 
fer it should be regarded as a crime. 

Mr. Martin. — I should like to know just how long 
a child's night should be. Our family rules for bedtime 
have been based altogether on guesswork. 

Mrs. Ross. — That seems to be the case in most fam- 
ilies, and it is aniazing to see how the guesses vary. 
There are established standards, however, which parents 
cannot afford to ignore. 

SLEEP REQUIRED FOR CHILDREN OF DIFFERENT AGES 
Recommended by Dr. T. D. Wood in Health and Education. 



AGE 


HOURS OF SLEEP 


TIME IN BED 


5-6 


13 


6.00 p.m. to 7 a.m. 


6-8 


12 


7.00 p.m. to 7 a.m. 


8-10 


iiy2 


7.30 p.m. to 7 a.m. 


10-12 


II 


8.00 p.m. to 7 a.m. 


12-14 


103^ 


8.30 p.m. to 7 a.m. 


14-16 


10 


9.00 p.m. to 7 a.m. 


16-18 


9^ 


9.30 p.m. to 7 a.m. 


18-20 


9 


10.00 p.m. to 7 a.m. 



70 HEALTH AND THE SCHOOL 

Here is a table which shows the number of hours chil- 
dren of different ages should be in bed. The estimate is 
a liberal one, and with certain vigorous children could 
be reduced half an hour without harm. It may also be 
remembered that the amount of sleep needed in summer 
is somewhat less than that needed in winter, very pos- 
sibly because of the greater amount of fresh air most 
children get in their sleeping rooms in warm weather, 

Mr. Martin. — I should be much interested to know 
how you would lay out the hours of the day for a ten- 
year-old child. 

Mrs. Ross. — Supposing that the time and length of 
the school session were to be modified, as we have sug- 
gested, and the school occupations properly adapted to 
the children, a daily program such as this would be 
wholesome for a ten-year-old child : 

7.00 — 7.30 a.m. Dress 

7.30 — 8.00 a.m. Breakfast 

8.00 — g.oo a. m. Light household duties and trip to school 

9.00 — 12.00 a. m. School 

12.00 — 12.30 p.m. Return home. 

12.30 — i.oop. m. Dinner 

i.oo — 1.30 p.m. Rest and light occupations 

1.30 — 2.30 p.m. Outdoor play and return to school 

2.30 — 4.30 p.m. School 

4.30 — 5.00 p.m. Return home 

5.00 — 6.00 p.m. Piano practice, entertaining. Younger chil- 
dren: housework or other useful employ- 
ment 

6.00 — 6.30 p.m. Supper 

6.30 — 7.30 p.m. Household fun 

7.30 — 8.00 p.m. Preparation for bed 

8.00 — 7.00 a.m. Sleep 

Mr. Young. — As our closing time has arrived, we can 
take but a moment to sum up the many important points 
which the evening's report has brought out. 



A SCHOOL CHILD'S DAY 71 

Physical zvelfare and groziHh the chief consideration. 
— The underlying principle, as I take it, in laying out 
the day's occupation for a school child is that every item 
in the program shall be scientifically adjusted to his 
physical capacity and wholesome growth, and that, even 
when this adjustment has been made, constant guard 
must still be kept by both parents and teachers to make 
sure that the demands of the daily program are not 
causing strain. 

Allowance for abundant physical activity essential for 
good health and good school work. — In the planning of 
a wholesome school schedule, abundant allowance must 
be made for muscular activity, as this is the most natural 
form of activity for children, and the means which brings 
their brains into the most energetic play. 

Frequent rest and recreation necessary to avoid fatigue 
and insure good digestion. — As children become fatigued 
very easily it is necessary to make their hours of work 
short and diversified, and followed by frequent pauses 
for rest and play. Two periods in the day should be 
especially dedicated to rest and recreation — the times 
following the noon and the evening meals. Digestion is 
evidently one of the chief concerns of childhood, and 
should not only be protected from interference by school 
demands, but carefully promoted by an opportunity for 
ease and pleasure after each important meal. No less 
important than nutrition is sleep, which must also be 
guarded from the encroachments of school work and of 
social diversion as well. 

As compared with the needs of the child, it appears 
that the demands of the school have been given scant 
consideration this evening. The latter must, forsooth, 
make way at every turn for some demand of the child's 
mere body — his digestion, his sleep, and even his play! 



72 HEALTH AND THE SCHOOL 

To what measures shall we teachers be driven? How 
can we get together our school exhibits and gather our 
fine files of examination papers if we aren't to put on the 
screws when occasion demands? 

I see only one way out of the difficulty. We must 
change our idea of what the product of the school should 
be. The torturing displays of midnight work done by 
pupils and teachers will no longer answer. Our rever- 
ently prepared and marked examination papers will have 
to go. What will there then be left to show what we've 
been teaching? 

Nothing but wide-awake, well-developed boys and 
girls ! 

Suggested Reading 

Arnold. School and Class Management, Part H, Chap- 
ter L 

Francis Parker School. Year Book, 1912. 

Holmes. The Conservation of the Child. 

Search. The Ideal School, Chapter VH-X. 

United States Bureau of Education. Provision for 
Exceptional Children in Public Schools. 

Wither. The Special Class for Backward Children. 



V 



COOPERATION WITH PARENTS IN SECURING 
MEDICAL AID 

Mr. Young. — Four weeks ago, when we learned that 
87 per cent, of the Washington school children were in 
need of medical treatment, we were told that prelimi- 
nary steps had already been taken toward securing the 
treatment. To-night the committee having this matter 
in charge will report to us the result of six weeks' work. 

Miss Parsons. — Before beginning our campaign we 
investigated the various methods of securing medical 
aid which were employed by cities having school med- 
ical inspection. We were astonished to find in many 
instances how little follow-up work was being done, and 
how small was the proportion of defects treated to the 
number discovered. Many reports placed great em- 
phasis on the large number of defects found, and 
these discoveries were apparently regarded as sufficient 
evidence of the usefulness and efficiency of the inspec- 
tion system. In one large city, for instance, the depart- 
ment of health could not show evidence that, of 65,000 
children whose parents had been notified of their de- 
fective condition, more than 8.5 per cent, had been 
treated. 

To avoid the danger of any such fractional result 
from our work, we realized that we must have the actual 
interest and cooperation of the parents. Parents of all 

73 



74 HEALTH AND THE SCHOOL 

kinds and conditions, when convinced that a certain 
course is for the good of their children, will do almost 
anything and suffer almost any sacrifice to accomplish 
it. A formal official notice, however, which invites a 
parent to have his child treated for a defect of which 
he has never before heard, does not carry much convic- 
tion, and in the great majority of cases is ignored. Most 
parents know little of pathological conditions, and are 
very properly timid about trying experiments on their 
children's bodies. 

Our problem, then, was to gain the confidence of the 
parents and to teach them how their children's health 
could be improved. We accordingly decided to reinforce 
the usual formal postal card notification with a little 
personal influence.* For this purpose we employed two 
nurses, to whom we gave records of the physical exam- 
ination and the recommended treatment for all the de- 
fective children. A few days after the formal notice of 
a child's defect was sent to the parent one of the nurses 
either visited the home or invited the parent to consult 
her at the school. In these personal interviews the 
nurse was able to make parents understand the nature 
of the defects from which the children were suffering 
and the necessity for having them treated. In most 
cases she advised the parents to consult the family physi- 
cian. When a family had no regular physician and no 
means to pay one, she suggested a dispensary. When 
the parents were unable to take children to a dispensary, 
she took them herself at their written request. 

The results of this personal work, which has thus 
far been carried on only six weeks, are very remarkable 

* Based upon an investigation in New York City by the Bureau 
of Municipal Research in 1908; reported in A Bureau of Child 
Hygiene. 



COOPERATION WITH PARENTS 75 

— 90 per cent, of the children who needed treatment hav- 
ing already been treated by either doctors or dentists. 
Of the 412 children who needed treatment 227 have 
been treated for all their defects; 144 for one or more 
defects, the remaining- defects to be treated as early as 
it is possible; while 34 children are waiting for treat- 
ment, which will be given as soon as it can be arranged 
for. This accounts for all but seven of the 412 children. 
In these seven cases, constituting less than 2 per cent, 
of the entire number, the parents would not consent to 
treatment for their children. You see by these figures 
that we have gained the active cooperation of more than 
98 per cent, of the parents, 

Mr. Ross. — Such a high percentage seems to me al- 
most incredible. Your nurses must have spent more 
time on each case than the ordinary school board could 
afford to allow. 

Miss Parsons. — On the contrary, I think you will 
see in a moment that our methods can be actually dupli- 
cated in the ordinary school, and that 98 per cent, of co- 
operating parents and even 100 per cent, is exactly what 
may be generally hoped for. As you know, our experi- 
ment has been carried on for the sole purpose of estab- 
lishing for all our schools an effective and economical 
method of following up cases needing medical treat- 
ment. The fact that our methods have been new, the 
nurses untried in this educational work, and the dis- 
pensaries unprepared to handle the unusual number, has 
made our work considerably slower and correspondingly 
more costly than it need be when it has become estab- 
lished. In spite of this handicap the cost of the nurses' 
service per child treated was only 60 cents. The amount 
of work done was really small, compared with the im- 
portance of its results. It required but one interview 



76 HEALTH AND THE SCHOOL 

with parents, half of whom came to the school, to bring 
about the treatment of 61.6 per cent, of the children; two 
interviews per case resulted in the treatment of 28 per 
cent, of the children; in only one case, which was 0.2 
per cent, of the whole number, was a third interview 
required. 

The result of our experiment has brought out the fol- 
lowing facts : 

1. Parents who have been made to understand the se- 
rious nature of their children's defects gladly respond 
to advice concerning treatment. 

2. The cost of personally enlisting the parents' inter- 
est through the work of nurses is not prohibitive. It 
can be made materially lower than 60 cents per child 
treated. 

3. The securing of facilities for treatment is still a 
problem. There are no agencies in our town for pro- 
viding reliable treatment, between the two extremes of 
the expensive practitioner and the charitable clinics and 
dispensaries. Some means must be devised either by our 
city government, our charitable agencies, or some other 
organized groups of citizens, for providing skillful medi- 
cal, surgical, and dental treatment for children at mod- 
erate cost or possibly at no cost at all. 

Mr. Young. — These conclusions have so important a 
bearing on improving the health of our school children 
that I should like to hear them further discussed. Miss 
Parsons had left us with no doubt that parents who are 
properly informed as to their children's defects will do all 
they can to correct them. She has also shown us that a 
very effective way of educating parents is through the 
work of school nurses. Their assistance is evidently in- 
dispensable for the following up of cases. 

Nurses, however, are far from being the only means 



COOPERATION WITH PARENTS 77 

of rousing parents to an active responsibility for their 
children's health. The educational possibilities of even 
formal official notices to parents have not been generally 
realized in this country, though excellent use is made of 
such notices by many cities in Germany. The city of 
Wiesbaden first devised a letter now in use in forty Ger- 
man cities, which is sent to parents before any physical 
examinations are made. It invites the cooperation of 
parents as follows : 

"For the better protection of the health of children attending 
the public schools, school doctors have been engaged to undertake 
the medical inpection of children on entering school, to be re- 
sponsible for their health as long as they attend the school, and 
responsible, too, for the school building from the point of view 
of the pupil's health. 

"These provisions will be of great use, both to the children 
and their parents. In the course of his education much will be 
learned with regard to the health and bodily conditions for each 
child, and this new knowledge, which is being gained now for 
the first time, the school doctors will put at the disposal of the 
parents, with whom henceforth they will work in the interests of 
the children. 

"Parents who, however, do not wish that their children should 
be examined by school doctors have a right to exempt them, as 
the nevr provisions do not refer to educational matters that are 
in any way compulsory. Such parents, however, must furnish 
the necessary information from their own doctor." 

Accompanying this letter is a request that in case the 
examination is agreed to, the father or mother or guar- 
dian of the child shall be present at the examination. 
This insures the immediate understanding of their chil- 
dren's defects. 

Mr. Ross. — Is this letter generally well received ? 

Mr. Young. — So well that 96 parents in 100 agree to 
the school examination. In Leipzig three-fourths of 
7 



78 HEALTH AND THE SCHOOL 

the parents of defective children act at once on ad- 
vice offered. Only 3.5 per cent, neglect a second 
warning. 

Miss Parsons. — While we are waiting for equally ef- 
fective systems to be established in the schools of our 
country, a strong educational influence can be exerted 
upon the home by principals and teachers through the 
children themselves. An observation recently made in 
Philadelphia shows how effective the sympathetic co- 
operation of a school principal may be in securing treat- 
ment for children. 

Two schools having the same inspecting physician 
and school nurse showed a difference of 50 per cent, in 
the number of defective cases treated during three 
months. The only radical difference between conditions 
in the two schools was that in the one the principal was 
indifferent to the work of the medical inspector, while 
in the other school the principal used active influence to 
carry out the inspector's recommendations. The methods 
employed by the cooperating principal were personal in- 
terviews, talks to classes, and addresses at parents' meet- 
ings in which he explained the children's defects and 
urged their treatment. 

Mr. Ross. — The second principal took a very impor- 
tant step when he called the parents together. In addi- 
tion to the excellent methods already proposed, I was 
about to suggest an association of parents and teachers 
whose object would be the promotion of children's wel- 
fare. Notable work has already been done by such or- 
ganizations in many cities, conspicuous among which are 
Boston and Philadelphia. 

Meeting at the school, the members of these clubs 
join with the teachers in considering the best ways of 
fulfilling their common task — the building up of citizens. 



COOPERATION WITH PARENTS 79 

The organization provides a center where advice can be 
sought and found and where study courses and lectures 
on health are made the means of presenting systemati- 
cally the knowledge that most parents sorely lack for 
the wholesome up-bringing of their children. Not only 
are such clubs potent means of educating their own 
members, but they are powerful agencies for securing 
wholesome school conditions for the whole community. 
The problem of persuading parents to give their children 
necessary treatment does not exist among members of 
an efficient parent-teachers' organization. 

Mr. Martin. — I have just been thinking that means 
ought to be found for doing away with this problem 
altogether. Though our discussion to-night has centered 
around the main question of how to persuade parents to 
give their children needed medical attention, and we have 
learned a number of effective means for accomplishing 
such persuasion, it seems to me that any system of per- 
suasion should be regarded only as a temporary make- 
shift. Must society always remain dependent on the 
mood or will or intelligence of individual parents for 
the health of its growing citizens? A child belongs to 
the state more absolutely than to its parents. The 
security of its health is of more material importance 
to the state than to the parent. Should not the state, 
then, have authority to coerce a reluctant parent and 
compel him to do all that is necessary for his child's 
health? Must we not have compulsory health as well 
as compulsory education? 

Miss Parsons. — You have brought up a tremendous 
issue, Mr. Martin. There can be no doubt that compul- 
sory health will some day — and that not a very distant 
day — be as firmly established in our country as compul- 
sory education now is. The day, however, waits upon 



8o HEALTH AND THE SCHOOL 

two things — a popular demand for compulsory health 
and facilities for its enforcement. 

We are all working" toward it now when we are edu- 
cating and persuading parents to have their children 
treated. Those cities that are beginning to have school 
and municipal dispensaries of various kinds are building 
up means for its enforcement. Indeed, there has already 
been one actual attempt made in one of our states to 
secure a law looking to the compulsory health of school 
children. In the winter of 191 1 a bill was introduced 
in the California legislature providing for the mandatory 
extension of "health and development supervision" to 
all the schools in the state, including the various state 
institutions for delinquents and defectives. Not content 
with the services of medical inspectors, the bill demanded 
that there should be "educators," experts in physiology, 
hygiene, and practical psychology, who could make a 
skillful diagnosis of the defective conditions of growth 
and development of school children. Such educational 
health experts who work side by side with skilled physi- 
cians are already employed in several California cities, 
notably in Los Angeles. 

The bill further provided for a State Bureau of Health 
and Development, whose function was to be the organ- 
ization and supervision of the state work, and the prose- 
cution of state wide investigation of the problems of hy- 
giene. The public schools were to serve as laboratories 
for the study of child hygiene; the normal schools were 
to train their students in educational hygiene; and the 
state university was to ofifer training for experts in hy- 
giene. 

The bill was splendidly conceived for uniting all the 
educational forces in the state for a sound and effective 
health program. It was warmly hailed by people who 



COOPERATION WITH PARENTS 



understood its promise of welfare for the next genera- 
tion, but, nevertheless, it met defeat without ever being 
brought to a vote in the House. So loud was the popu- 
lar clamor against it that the assembly committee to 
which it had been referred felt obliged to smother it. 

Mr. Young. — The popular clamor against such a valu- 
able measure can only be accounted for in one way. The 
people did not understand its significance and value. 
The defeat of that bill emphasizes the lesson that many 



^OICNOEin) 



Location of 
Adenoids 

SHOWN X 




Adenoids 

cause mouih- 

breaihiirg. ■) \;p^ 

freouentcolds, i\yA^^^^^^^ 

and deformilv of Ihe 
jaw and chesh 

TTiev induce slupidilv and c^ko^ 
siunt mental ahd physical grovlh. 

DON'T LET Y0UR.CH1LB 
BE. ^O HANDICAPPEX1>. 

Removal of Adenoids 
15 a simple and brief operation. 

GIVE. YOUR CHILD 
A CHANCE TO BRJE-ATHE 



PARENTS WILL HELP WHEN THEY KNOW HOW. 

Such graphic appeals as these will go far toward enlisting the in- 
telligent and active support of parents in a constructive program 
of child hygiene. From the Weekly Bulletin of Sanitary In- 
struction published by the Chicago Department of Health. 



82 HEALTH AND THE SCHOOL 

reformers are slow to learn. It is useless for legislation 
to attempt to outrun public opinion. That same bill or 
one equally sweeping will yet pass in California, as in 
all our other states, but not till we get enough voters 
enlisted for it. 

Dr. Latta. — This work of enlistment is going stead- 
ily forward under the leadership of able officials who are 
demonstrating the value of health laws as they exist 
to-day. For example, in Rochester the health officer, 
by thoroughly enforcing the present health requirements, 
is constantly educating the whole city to insist on health 
rights not yet provided for by law. Convinced of his 
interest in their children's welfare and his knowledge of 
the best means to secure it, the parents of Rochester al- 
lowed him, even before he had the legal right to do so, 
to impose his own restrictions in granting working 
papers. Ohio in 1910 passed a law providing that a 
working certificate must certify that the child is in proper 
physical condition to do the work he is employed to do. 
This law is being strictly enforced in Cincinnati, where 
it is interesting to note that about 50 per cent, fewer 
working certificates are now being granted than there 
were five years ago. 

Mr. Young. — Rochester and Cincinnati are evidently 
solving the problem which we have had under discussion 
this evening — how to win the cooperation of parents in 
promoting the health of their children. Our discussion 
has brought out a number of important points which we 
may sum up briefly as follows : 

Under present laws school children cannot receive nec- 
essary medical treatment without their parents' permis- 
sion. 

Parents readily grant such permission when they un- 
derstand the necessity. 



COOPERATION WITH PARENTS 83 

Parents can be successfully instructed by means of 
official bulletins; by the personal influence of nurses, 
teachers, principals, and children; by lectures, exhibits, 
and study classes given under the auspices of school 
boards or associations of parents and teachers, or any 
other organization whose object is the promotion of chil- 
dren's welfare. 

There is evidently no more hopeful field of endeavor 
in connection with children's health than educational 
work with parents. The success of such work, where 
it has been fairly tried, shows clearly that the real solu- 
tion of the problem of securing health for children lies 
in an enlightened parenthood. 

Suggested Reading 

American School Hygiene Association. Proceed- 
ings OF the Sixth Congress. The School Nurse 
as a Link in the Chain of Preventive Medicine. 
Health Problems Encountered in Home Visits to 
School Children. 

Denison. Helping School Children, Chapters VI-IX. 

Grice. Home and School. 

National Society for the Study of Education. 
Ninth Year Book, Part II. School Nurses. 



VI 

PROVISION FOR MEDICAL AID 

Mr. Young. — We have found that parents are eager 
to secure medical and dental service for their children 
when they realize the need for it. But how are they 
all to secure it? We met abundant difficulty in provid- 
ing treatment for even the 412 school children whose 
cases we reported last week. How can we get the re- 
maining 4,600 children looked after? 

Mr. Ross. — I think that burdensome question should 
not fall on the school to answer. Let the parents solve 
it individually. 

Mr. Young. — If they could, that would certainly be 
the simplest way. But many of the parents have not 
the time, intelligence, or money to seek out or to pay 
doctors and dentists who are qualified to treat their chil- 
dren. The average parent of restricted means is in a 
rather helpless situation. He is neither rich enough nor 
poor enough to command very good medical, surgical, 
or dental service. 

Mr. Ross. — What can you mean? 

Mr. Young. — Exactly what I say. I have the word 
of a prominent New York physician to the effect that 
only two classes of people in our country are at present 
getting the best medical service. These two classes are 
paupers and millionaires ; and, on the whole, the paupers 

84 



MEDICAL SERVICE 85 

seem to come off best, because they are invariably treated 
in hospitals, where doctors demonstrate the latest meth- 
ods and every modern appliance is at hand. If our 
school children could be reduced to beggary the problem 
of providing them with medical treatment would be much 
simplified. As most of them, however, belong to self- 
respecting families who can afford to pay something, 
but not much, for medical service, the problem presses. 

Mr. Ross. — Won't the free dispensaries accommodate 
those who can't pay ordinary doctors' fees? 

Mr. Young. — Certainly, so far as their resources al- 
low. The charitable dispensaries were of great service 
to us in getting the Washington school children treated, 
but they would be swamped if all the needy school chil- 
dren in town were to apply to them. 

Mr. Ross. — What alternative is there, then? 

Mr. Young. — There is only one logical one. If our 
town is to make the health as well as the education of 
its children compulsory, as it doubtless will before long, 
it must supply means for the enforcement of health as 
well as education. Free professional aid, which includes 
not only diagnosis and treatment — medical, surgical, and 
dental — but advice as to daily hygienic living, regulation 
of diet, and necessary nursing, will have to be supplied 
to all children who need it or who prefer it to private 
treatment. 

Mr. Ross. — But that is socialism. 

Mr. Young. — Is it socialism any more than to supply 
free schools and textbooks? The community expends 
enormous sums on education to protect itself against 
ignorance in the coming generation. Can it invest fur- 
ther sums more profitably than in guarding itself against 
the burden of ill health in the next generation? Free 
medical treatment supplied by town or state for the sake 



86 HEALTH AND THE SCHOOL 

of securing sound citizens is no more a charity than is 
pubHc school education. 

The safeguards to health that our community is al- 
ready providing are nowhere considered socialistic or as 
exploitations of rich taxpayers for the benefit of poor 
ones. Our sewers, our garbage collection system, our 
street cleaning, our present expensive draining of the 
outlying swamps, and all our other sanitary enterprises 
are being cheerfully supported by the taxpayers for the 
sake of fostering the health of the whole community. 
When, in spite of such general sanitary precautions, the 
health of any individual fails, is it not for the best in- 
terest of the public to supply prompt and effective rem- 
edial measures? 

Dr. Latta. — England has certainly concluded that it 
is. Who would have believed a short time ago that the 
year 1913 would see a free public medical service thor- 
oughly established in England? 

Mr. Young. — Personal medical treatment at public 
expense, and public sanitation are really not different in 
principle. The health of every person in the community 
is the thing sought for in each case. Since the burden of 
ill health of any of its members falls on the whole com- 
munity in the long run, it is far more economical for the 
town or state to pay whatever sums are necessary for 
preventing or checking sickness than to suffer the back- 
breaking cost of unchecked disease. The present free 
distribution of vaccine and the various antitoxins for 
diphtheria, tetanus, meningitis, and typhoid is notable 
evidence that society has already found out the profit 
there is in laying out money for the prevention and cure 
of these formidable "catching" diseases. It will not be 
very long before it is recognized to be worth while for 
public medical officers to treat, at public expense, any 



MEDICAL SERVICE 87 

form of sickness that may arise in the community, or 
at least to exercise supervision over the cases where pri- 
vate treatment is preferred. 

Mr. Ross. — What about the private doctors? Will 
they ever consent to letting their patients slip out of 
their hands in any such wholesale fashion? 

Dr. Latta. — Not just yet, certainly. Bellinzona, a 
town in Switzerland, not long ago tried to municipalize 
its medical service, with the result that 56 of the 58 
private doctors went on strike. Lloyd-George in Eng- 
land has also encountered some difficulty in securing 
medical care for the beneficiaries of his new social in- 
surance system. The British Medical Association was 
incensed at the medical provision in the act and threat- 
ened a general boycott. 

In a war between doctors and patients, however, the 
latter have the unconquerable advantage of numbers. 
The handwriting has already appeared on the wall, and 
the shrewdest as well as the most public-spirited of the 
younger men are preparing themselves for the field of 
public health service, where the greatest usefulness is to 
be attained, and the highest laurels are to be won. 

Mr. Martin. — While we are waiting for the enlight- 
ened day of free medical service, what can we do to meet 
the immediate exigencies of our school children? 

Mr. Young. — The most effective course that has been 
found in attacking such a wide public need is to call 
together city officers and representatives of as many 
private welfare organizations as possible for the purpose 
of formulating a concerted campaign. Until this most 
important step is taken it is impossible for a town to 
estimate its resources. A study recently made in New 
York City has revealed an amazing number of agencies 
(119) whose energies can be used for the welfare of 



88 HEALTH AND THE SCHOOL 



SOME OF THE EXISTING AGENCIES, PRIVATE, PUBLIC, AND SEMI- 
PUBLIC, WHICH CAN BE UTILIZED FOR IMPROVING 
THE HEALTH OF CHILDREN 

Adapted from a Compilation by G. Stanley Hall 

I. Hygienic ' 

Fresh Air Work 

Milk Commission or Depots 

Public Baths and Gymnasia 

Societies for the Prevention of Tuberculosis 

II. Recreational 

Boys' Clubs and Camps 

Girls' Clubs and Camps 

Park and Recreation Commissions 

Playground Associations 

Shut-in Societies 

Vacation Schools 

III. Relief for Sick Children 

Children's Hospitals, Dispensaries, Convalescent 

Plomes 
Diet Kitchens 
District Nurses 
Free Dental Associations 
Institutions for Crippled, Epileptic and Nervous 

Children 

IV. Child Welfare 

Children's Bureau 

Medical Inspection of Schools 

Open-air Schools 

Parents and Teachers' Associations 

Public Education Associations 

Visiting Nurses 

V. General Welfare 

Conferences, Surveys, and Exhibits 
Relief and Aid Societies 
Women's Clubs 



MEDICAL SERVICE 89 

school children. The amount of money these agencies 
spend for the direct help of the schools is not less than 
a million dollars. Seventy-six of them offer direct, con- 
tinuous, and gratuitous cooperation with the schools. 
The report on this study shows further how by cooper- 
ation and central supervision of some kind the efficiency 
of these private agencies can be enormously increased. 
I recommend this report, as well as a further study re- 
cently made, which covers communities throughout the 
country, as most instructive examples of how to make 
every possible agency count for its maximum in carrying 
out any welfare program.* 

We have in our own town a number of charitable 
societies, social improvement clubs, home and school as- 
sociations — lately formed — and medical organizations of 
various kinds. Each one of these societies is interested 
to see a health program for our school children carried 
out. By uniting their efforts they can go far toward 
doing it. At an informal conference which we have al- 
ready held, the officers of these various societies pledged 
their influence to forward the school children's health 
movement and particularly to gain the cooperation of 
their clubs in securing the treatment which the children 
now need. 

The plan is as follows : The Woman's Club is to pay 
for three nurses who will treat the children's minor ail- 
ments, give home instruction, and assist in surgical cases. 
The Dental Society is to provide free service three af- 
ternoons a week until the needy children now requiring 
attention are cared for. The Society of Physicians and 
Surgeons is similarly to guarantee medical and surgical 

* Outside Cooperation with the Public Schools of Greater 
Neiv York, Bureau of Municipal Research, New York. 
Helping School Children, Elsa Denison. 



go HEALTH AND THE SCHOOL 

treatment; the Home and School League is to bear the 
cost of medicines and dental and surgical appliances, 
and the town hospital to accommodate, free of charge, 
the children whose cases call for more than a day's nurs- 
ing. 

While this plan is not an ideal one, making as it does 
so many of the children dependent upon charitable en- 
terprise, it is, nevertheless, an enormous step in advance 
for us. Not only will our children get the treatment 
they need, a great good in itself, but, owing to the wide 
publicity that will be given to the work of the various 
clubs, the whole town will be impressed with a striking 
lesson in the public's responsibility for the health of its 
growing members. 

Mr. Ross. — Is such a program as you describe in 
actual operation anywhere? 

Mr. Young. — To be sure, with many local variations 
of course. In a number of communities philanthropic 
efforts, which are the conspicuous feature of our pro- 
gram, have already served their temporary purpose and 
been succeeded by public enterprises. The inauguration 
of free dentistry in the schools of 48 of our cities is one 
of the direct outcomes of initial charitable work; so is 
the appointment of over 500 school nurses in more than 
150 cities, as well as of many public nurses in rural com- 
munities. 

The recent establishment of divisions of child hygiene 
in New York and Philadelphia, as outcomes of philan- 
thropic endeavor, is the most notable step yet taken for 
the physical welfare of children by any cities in our coun- 
try. With an annual outlay of over $500,000, the bureau 
provides for the physical examination of all the school 
children, and aims to supply treatment to all children who 
require it and are unable to pay for it. In addition to 



MEDICAL SERVICE 91 

these concerns it watches over the sanitary conditions of 
both home and school, gives home instruction in the care 
of children, and provides milk stations where pure milk 
can be bought at moderate cost. This pioneer work is of 
great significance ; it will exert a profound effect on all 
our American cities. 

In many cities which have not yet taken the advanced 
position of New York, philanthropic societies are co- 
operating effectively with the school authorities in secur- 
ing medical treatment for children. Los Angeles, in the 
arrangements which it completed in 1912, has developed 
a combination that is giving great satisfaction for the 
present. The school board of that city, with the aid of 
the Children's Hospital Association and the Parent- 
Teachers' Association, stands prepared to give freely to 
needy children whatever expert medical attention they 
require. The treatment is given in two perfectly ap- 
pointed buildings erected by the School Board on land 
belonging to the Children's Hospital, the salaries of doc- 
tors and nurses being paid by the Parent-Teachers' As- 
sociation. One of the buildings is equipped to accom- 
modate various kinds of cases that can be treated in a 
single day. Here the children's eyes, ears, noses, throats, 
and teeth are treated by both men and women doctors 
and dentists. Circumcision is also provided for. In the 
second building, which is a carefully conducted hospital, 
children may remain as long as necessary, the Parent- 
Teachers' Association paying the bills. 

Miss Parsons. — Los Angeles may well regard this 
thorough provision for its children's health with pride. 
The plan indicates an advanced sense of public duty 
with respect to children, but the arrangement, liberal as 
it is, has not yet reached its final form. Eventually all 
the school children will be free to come for treatment 



92 HEALTH AND THE SCHOOL 

and the city will pay all the bills. Los Angeles, as well 
as other similarly disposed cities, will in time shake it- 
self free from dependence on any charity, such as the 
Children's Hospital Association, for the care of its chil- 
dren, and it will furthermore cease to single out un- 
fortunate children to become recipients of special town 
benefactions. 

Mr. Ross. — But why shouldn't the poor children be 
the ones to receive these benefits? They certainly need 
them, and the others don't. 

Mr. Young. — Such an arrangement is essentially un- 
democratic. All children have a right to health as well 
as education, and none should be humiliated by securing 
it under conditions of special dependence. Many so- 
called charities, both private and public, are a constant 
confession of injustice in our social and industrial sys- 
tem. 

Mr. Ross. — That's a queer sounding remark, Mr. 
Young. What would become of the social order with- 
out the leaven of charity? 

Mr. Young. — We don't want to part with chanty, 
Mr. Ross, but with certain injurious forms which it 
now takes. Some of our charities actually encourage 
social injustice by alleviating and hiding distress which 
should be heralded abroad as indications, for example, 
of impossible living wages or deadly housing conditions. 

Mr. Ross. — The charity that provides medical treat- 
ment for poor school children can hardly be charged 
with shielding greedy employers and landlords. 

Mr. Young. — Possibly not — but, however that may 
be, the children of a community should not be dependent 
for their health on the voluntary offering of certain citi- 
zens. To be sure, with the many forms of injustice 
still operating in society, we cannot as yet spare the 



MEDICAL SERVICE 93 

direct benefactions of generous men and women who 
are blazing the way for pubHc benefactions that will be 
received as a right. Universal justice, when it comes, 
will mark a far higher stage of social evolution than is 
possible under a regime of private charity, however 
princely. Justice, for instance, demands that every hu- 
man being shall have health as a right and not as the 
voluntary offering of his neighbor. 

Miss Parsons. — And is not this view daily gaining 
wider acceptance? Cooperation among those concerned, 
and not dependence on an outside agent, is proving to 
be the only sound basis for any permanent social better- 
ment. In our war on disease we are beginning to real- 
ize the tremendous power that lies not only in organized 
philanthropy, but in organized common effort that is 
not dependent on philanthropy. 

The valuable health measures that many of our states 
and cities are adopting, such as the suppression of com- 
municable diseases and the care of tuberculous cases, are 
activities, democratic in the sense that they are not de- 
pendent on philanthropy, but not yet democratic as re- 
gards the distribution of benefits. The free public care 
of the sick and the distribution of remedies and prophy- 
lactics are still limited largely to actual dependents or 
impostors. To be thoroughly democratic a general tax 
for the treatment of disease should carry with it the 
right of every taxpayer to profit by it. 

Dr. Latta. — Such a democratic scheme, carried on 
privately, it is true, is proving remarkably successful in 
the University of California, where 4000 students receive 
expert medical care, minor surgical treatment, and pre- 
ventive advice for a flat fee of $3.00 a year. The doctors 
and surgeons, employed in this cooperative service, are 
very able men, receive good salaries, and are highly 
8 



94 HEALTH AND THE SCHOOL 

pleased with the opportunity of pursuing their profession, 
free from the harassing consideration of fees. 

Mr. Young. — On even a larger scale has been the work 
of certain semi-public cooperative societies, notably the 
very successful sickness insurance companies of Germany. 
In our own country the life insurance companies have 
been the most conspicuous leaders among non-charitable 
organizations in a nation-wide campaign against disease. 
To take a single example, in 1909 one of our leading in- 
surance companies launched the novel plan of nursing its 
sick policyholders and destroying the diseases that 
threatened them. Though the contract of the company 
calls only for the payment of a death benefit, the directors 
believe it is profitable as well as humane to postpone 
the death of policyholders by laying out money to keep 
them well. To this end they inaugurated a thorough 
educational campaign, as well as an actual nursing sys- 
tem by which nurses' services are supplied promptly and 
without cost to sick policyholders as long as there is 
need. 

The records of the company already show innumerable 
cases where distress has been relieved, lives saved, and 
earning capacity restored by the work of the visiting 
nurses. The extent of the service has been enormous. 
In the first six months of 191 1 there were over 320,000 
visits made by nurses in 473 cities and towns. The 
company is planning to extend its work over the entire 
country at an annual cost of over $500,000. 

In addition to providing nurses' care for the sick, this 
company distributes health bulletins that reach regularly 
about 15,000,000 people. When tuberculosis is found 
the sufiferers are given every practical direction that 
modern science offers for a successful fight against this 
disease. Suggestions for diet, clothing, and daily habits 



MEDICAL SERVICE 95 

are plainly set forth, along- with photographs, designs, 
and specifications for inexpensive sleeping porches and 
all other arrangements for open air living. 

Simple and thorough directions are also supplied for 
preventing the spread of disease. It is in the line of 
prevention that the company is probably doing its most 
remarkable work. Realizing the immense economic ad- 
vantage of preventing disease rather than curing it, the 
officers provide policyholders with sound and practical 
directions for the sanitary care of their homes and fam- 
ilies. Even the children holding policies have been or- 
ganized into a Health and Happiness League, whose 
pledge is a series of promises that make for the health 
and happiness of the members and all whom they meet. 

Miss Parsons. — The health campaign of this life in- 
surance company, conducted as it is on a gigantic scale 
and by the most expert methods, is a profoundly signifi- 
cant thing. Here we have open to 6,600,000 men, 
women, and children in one organization alone, a great 
benefaction, whose basis is not charity but business pol- 
icy. The benefaction is regarded not as a privilege but 
as a right, for the cost of it is maintained by the people 
who are benefited. Such thorough work as this insur- 
ance company and others are doing will undoubtedly 
serve as a model for whole communities that are begin- 
ning to realize the economy of promoting health. 

Dr. Latta. — In the meantime the full resources of 
the life insurance companies should be brought into 
play in the work of health education. The extent of 
their influence is enormous. Our leading companies 
have a trained force of 80,000 medical examiners — a 
greater force than our standing army — as well as 20,000 
agents, all of whom are constantly at work among 20,- 
000,000 policyholders. The educative power of these 



96 HEALTH AND THE SCHOOL 

great organizations has as yet hardly been tapped. In 
fact, we must turn to the fire insurance companies to 
gain a really adequate idea of the incredible saving from 
loss that can be accomplished by a scientific course of 
prevention. Let me quote Professor Irving Fisher in 
this connection : "The fire insurance companies maintain 
a laboratory at Chicago, where building materials are 
tested as to fire resistance, and they have done so much 
in the way of fire prevention that the insurance rate on 
cotton and woolen mills, for instance, has fallen from 
$3.00 to $4.00 per $1,000 to 7 cents! The life insur- 
ance companies can do as much to prevent disease 
as the fire insurance companies have done to prevent 
fire." 

Mr. Ross. — I should like to know whether the experi- 
ment of the life insurance company which Mr. Young 
has cited has paid financially. 

Mr. Young. — That cannot be definitely determined 
for some years, though there are already strong indica- 
tions that it has. In a number of cities, for instance, 
where the nursing service has been conducted, the death 
rate has decreased much more than it has done in other 
cities of the same size and similar industrial conditions 
but unprovided with nurses. The managers are confi- 
dent that events will prove the economy of their course, 
which they declare is the only practical way of meeting 
the responsibility they owe to the people who support 
the company. They believe that a life insurance com- 
pany must actually insure life, if it is to prosper in the 
end, and that the time is passing when the people will 
tolerate the grim irony in the term life insurance which 
is now taken to mean death insurance. 

Dr. Latta. — There is little reason to doubt that re- 



MEDICAL SERVICE 97 

ducing death losses through health conservation will 
prove highly profitable to insurance companies. Certain 
insurance statisticians have calculated that an outlay on 
health of only i per cent, of the annual income would 
save enough lives to give the companies a profit on the 
investment of at least 100 per cent. 

Mr. Young. — Some such organized protection of 
health as the insurance companies are developing will 
in time gain general adoption. Whether the protection 
can best be provided by private insurance companies, 
or such government-supervised societies as are now flour- 
ishing in Germany, or through direct public administra- 
tion by state, as in England, are questions of method 
that will gradually be adjusted. Whatever final form 
these organizations may take, they will necessarily be 
established and conducted according to two fundamental 
principles which have already made themselves very clear. 
These principles have as vital application to our own lit- 
tle question of treating the town school children as to 
the largest health problem before the human race. It 
will be worth while to state them. 

I. The best and most economical machinery for con- 
serving health can he operated only by strong organiza- 
tions which can command the services of experts in 
medicine, education, and scientific management. 

Since it is to the interest of all society as well as 
to the individuals directly concerned that the most effi- 
cient and economical machinery be employed for keep- 
ing every one in health and exterminating every disease, 
society for its own protection will be compelled to de- 
vise means not only for bringing organized methods of 
treating and preventing disease within the reach of all, 
but of compelling their use. General health taxation of 



98 HEALTH AND THE SCHOOL 

one kind or another, and general free treatment of dis- 
ease, will be the final result of this necessity. The first 
public step in this direction will be medical aid for school 
children at public expense. 

Mr. Ross. — I can't see why they should have it. It 
isn't at all democratic to make one set of people help 
pay the bills resulting from the indiscretions of another 
set of people. 

Miss Parsons. — You cannot dismiss the causes of 
children's diseases by calling them indiscretions. They 
have far more sinister names than that. These are 
poverty, vice, ignorance, and mismanagement. The pub- 
lic schools themselves, we have found, are among the 
agencies that are needlessly injuring the health of our 
children. Should not the town and state that control 
the schools, and which have compelled the children to 
attend them, at least be required to repair the untoward 
damage inflicted through compulsory school attendance? 
And, further, should not society as a whole pay the cost 
of the poverty, vice, and ignorance which it peniiits to 
prey on the health of its weakest members, and through 
these on the health of all? Those who suffer most from 
such afflictions have least power to remove them. The 
curse can never be lifted unless the whole of society 
gets under the load. 

Mr. Young. — Taxation on account of the preventable 
sickness of others, in addition to being fundamentally 
just, has the further advantage of serving as a power- 
ful stimulus to the stronger members of society to re- 
move the causes that are dragging the whole structure 
down. It is only by bringing the handling of disease 
under public administration, making the cost of it a 
public burden, and, furthermore, the reduction of it the 
chief motive to those who treat it, that we can hope to 



MEDICAL SERVICE 99 

reduce sickness to a minimum. This brings us to the 
second principle which must govern the effective con- 
trol of disease. 

2. Si7ice the stamping out of all preventable sickness 
and the upbuilding of health are aims of far greater 
consequence in any organized health program than the 
mere treating of such sickness, it is necessary to provide 
physicians tvith sound economic motives for giving their 
best endeazror to positive health culture and to the pre- 
vention rather than to the cure of disease. 

Our present method of employing doctors merely to 
attend us in illness, and not to keep us from contracting 
it, is an appalling handicap to the usefulness of the 
profession. The ordinary private physician is in a hope- 
less dilemma where his professional zeal for reducing 
the sickness of mankind conflicts vitally with his very 
real need of patients. In spite of this clash of inter- 
ests many of our physicians, led by high ideals of public 
service, are taking time from lucrative practice to give 
unpaid help to the various health movements. How 
much more might these men accomplish if such public 
work were made their actual profession and not the 
efforts of a few stolen minutes ; if their highest public 
service were made to harmonize with their own private 
interests. 

Mrs. Ross. — In that case the children's specialists 
would win their laurels not from the number of desper- 
ate cases they had snatched from death, but from the 
number of children they had kept from sickness alto- 
gether. 

Dr. Latta. — Exactly. Our greatest children's doctor 
would be the wisest counselor in child hygiene, and not 
necessarily the most skillful wrestler with mortal dis- 
ease. Where the "treating" physician at his best can 



lOO HEALTH AND THE SCHOOL 

save but a hundred lives, the efficient hygienist may save 
ten thousand. 

The pubHc does well when it captures the best pri- 
vate physicians for the wider field of public service and 
rewards them appropriately, with both honor and in- 
come. If the health of society were in the hands of 
wise public physicians who were free to put into prac- 
tice all the sanitary knowledge now available, and whose 
salaries were to be increased as the number of patients 
diminished, sickness would flee from the earth at a pace 
we can never hope for under our present benighted sys- 
tem of paying a premium on it. 

Mr. Ross. — I can't see where you will stop if you 
begin to give free medical care at public expense. Why 
not nourishing meals and airy bedrooms as well? 

Miss Parsons. — Why not, indeed, if that were the 
most efifective way of obtaining these prime necessities? 
Society can ill afford to let any of its members lack 
them. Since they are universal daily needs, however, 
they can be obtained only by universal daily effort. No 
insurance organization can be devised to feed all its 
members every day. The treatment of the sick, on the 
other hand, is an occasional burden pressing heavily on 
but a few individuals at a time. A slight general tax, 
which would burden no one, would insure all against the 
risk of disease. Sick benefits are absolutely different in 
principle from daily dispensations of bread and butter. 

Mr. Young. — The question of good food and hous- 
ing which Mr. Ross brought up is not, however, out of 
place in our discussion of the treatment of defective 
children. While, as Miss Parsons says, there is no way 
for the ordinary man to dodge the responsibility of 
working for the reasonable necessities of life, it is fur- 
ther true that thousands work hard for them and never 



MEDICAL SERVICE loi 

get them. In fact, the problem of securing healthful 
living conditions is far less simple than the question of 
medical care. It involves the government regulation 
of wages, of trusts, of food preparations, of housing 
conditions, of unemployment, of child labor, and nu- 
merous other economic puzzles. 

Mr. Ross. — If the w^hole matter is so involved as you 
indicate, what good will a little free medical treatment 
do, anyway? If the cause of school children's ill health 
lies in bad living conditions, seeing the doctor isn't go- 
ing to help. Why shouldn't society solve its funda- 
mental problems instead of going to a lot of expense in 
patching up mistakes? I must confess that I can't see 
why free medical service for the public in general, and 
for school children in particular, is a whit more im- 
portant than scores of other benefits which every one 
would like to have but can't. 

Mr. Young. — The health of the public in general and 
of school children in particular is the very core of the 
nation's life. We cannot wait for the social readjust- 
ments to take place that will insure healthful conditions 
for all. The school children are suffering now; the 
coming generation is threatened now. It is not a ques- 
tion of pauperizing individuals ; it is a question of sav- 
ing the strength of the state. This lesson has just been 
dearly learned by England. The Boer war revealed an 
appalling decline in the vigor of her manhood. Why? 
Because for three generations she was indifferent to the 
physical welfare of her children and their working par- 
ents, who were wearing out their lives in the mills. 

Our own country is as yet full of fresh life. How 
can we best preserve it? By giving a free hand to our 
doctors, who should be our public servants, responsible 
to the public not only for the cure and prevention of 



I02 HEALTH AND THE SCHOOL 

our diseases, but for the upbuilding- of our national 
health. 

Suggested Reading 

Bureau of Municipal Research^ New York. Outside 
Cooperation with the Public Schools of Greater Nezv 
York. 

Dawson. Social Insurance in Germany. 

Denison. Helping School Children, Chapters HI, IX, 
XHL 

GoRST. Children of the Nation. 

Hall. Educational Problems, Part H, Chapter XI. 

Seager. Social Insurance, Program of Social Reform. 



VII 

TEACHING CHILDREN THE ART OF HEALTH 

Mr. Young. — Our last two discussions have con- 
vinced us that the chronic diseases and defects of school 
children which have until very lately been ignored can 
be properly treated only by the schools taking a hand. 
Provision for necessary treatment and enforcement of 
it are evidently among the greatest responsibilities of 
public schools to-day. 

There is one responsibility still greater. This is to 
teach children how to be well. Medical treatment, while 
indispensable, is only repair work. Much that is now 
needed would be unnecessary if the children had lived 
under proper conditions and practiced healthful habits. 
Far more important, then, than the patching up of im- 
paired children is the duty of teaching children how to 
keep out of the repair shop altogether. To give sound 
health training is the most important educational work 
of the schools. 

We have been teaching hygiene for many years, but 
have we ever succeeded in developing hygienic habits 
among our children? Why haven't we? Because we 
have presented the subject as a theory of health and 
nothing more. What our children need to learn is the 
art of health. How to convert the theory into practice 
is what we wish now to consider. 

103 



104 HEALTH AND THE SCHOOL 

SCOPE AND METHOD OF HEALTH INSTRUCTION 

With a view to getting new life into our health in- 
struction, both at school and at home, I wish to submit 
to your approval a few recently developed standards as 
to matter and method in teaching hygiene. Let us first 
consider the amount and kind of the instruction that 
should be given, together with the relation this should 
bear to the rest of the curriculum. We will then discuss 
special methods for enlisting the cooperation of the chil- 
dren in practicing what they learn. 



CONSTANT INSTRUCTION WHICH IS CORRELATED WITH 
OTHER STUDIES 

So important is it for everyone to have as thorough 
and practical a knowledge of hygiene and sanitation as 
possible that these subjects should be kept before pupils 
throughout their school course. This should not be done 
by presenting them as isolated studies. Since daily prac- 
tice, and not the storing up of theory, is the great object 
in view, it is necessary to bring the principles of health- 
ful living into closest possible connection with all the 
interests and activities of children. These principles 
can be brought in naturally with a score of school oc- 
cupations and studies : weather observations, games, and 
festivals, nature study, primitive life, industries, and 
discussions of social and ethical questions. 

Mr. Ross. — Do you think such incidental attention to 
these subjects would be enough? Is it not necessary for 
the children to make some separate textbook study of 
them? 

Mr. Young. — To be sure, children need a certain 



HEALTH INSTRUCTION 105 

amount of book study to focus and coordinate the ideas 
which they should be receiving constantly through other 
sources. Good primers of hygiene and sanitation are 
indispensable aids in health instruction. Their contents 
should, moreover, be largely mastered before the sixth 
grade is reached, in order that the school deserters, who 
flock off at that year, may be included in this instruc- 
tion. 

Textbook study, however, should never be regarded 
as an end in itself. Books on hygiene and sanitation 
are most valuably employed when used as reference 
books in studying subjects of more vital appeal than 
abstract health. The stuSy of home life or town and 
country industries, for example, offers many interesting 
problems which can be solved only by acquiring a fairly 
thorough knowledge of certain phases of hygiene and 
sanitation. The children consequently consult books on 
health to find out facts that they are eager to know in 
their broader connections, and thus receive a strength 
of impression quite impossible were the same facts to 
be arbitrarily set before them as lessons to be learned. 

Mr. Ross. — Has everything in the schools got to be 
dressed up so that children shan't know they are work- 
ing? 

Mr. Young. — We are not trying to beguile the chil- 
dren into work, Mr. Ross. We are merely offering them 
sound motives for putting forth their efforts. Do 
grown people work without good reason? Why should 
children? It is a profoundly immoral thing to make 
children perform what seem to them irrational tasks. 
Is not the wisest and most reasonable disposition of 
his time the thing that marks the man of highest de- 
velopment? Is not the hopeless misdirection of his ef- 
forts the mark of the inefficient man? Are we teachers 



io6 HEALTH AND THE SCHOOL 

to dull the natural discrimination of children and train 
them to inefficiency by setting them at work which to 
them has no value? Surely the more important a sub- 
ject of instruction is, the more important is it that this 
should be presented in a way to appeal to the children's 
active interests. 



TECHNICAL STUDY IN THE HIGHER GRADES 

After the fundamental principles of hygiene and sani- 
tation have been acquired in the earlier grades, the up- 
per elementary and high school grades may offer more 
technical study through manuals dealing with first aid, 
care of young children, methods of public sanitation, and 
prevention of disease, but this more special study should 
be conducted for the most part like the earlier health 
study. It should still be made incidental to broader in- 
terests, such as history and civic life. 

Mr. Ross. — Your scheme may be ideal, but is it prac- 
tical? I should fear that teachers and pupils would get 
so hopelessly tangled up in trying to weave all their 
strands of knowledge into one garment that their minds 
would be in great danger of going bare. Have these 
extraordinary theories ever really been put into practice ? 

Mr. Young. — They have, indeed. I was about to re- 
fer to a detailed outline of just such health instruction 
which is now being successfully carried on in Speyer 
School, New York. I have here, in fact, a brief outline 
for work in the eighth grade of this school. The whole 
program, which is published in Teachers' College Record, 
May, 1912, will prove immensely suggestive to teachers 
who are trying to put life into health instruction and 
don't quite know how to do it. 



HEALTH INSTRUCTION 107 



HEALTH IN ITS RELATION TO LIFE 

Approach : Interest in Community Life Through the 
Study of History and Civics 

General Scheme 
I. The meaning of health. (October) 

I. The relationship of health to citizenship. 

II. How does it pay to be well? (November) 

1. A personal consideration. 

2. A civic interest. 

3. Why good health pays. 

III. The value which the school places upon health. 

(December) 

IV. How the city protects its citizens. (January) 

1. Health protection. 

2. Protection of property and rights. 

3. Protection against accidents. (February) 

4. Protection against disease. 

V. National protection. (March) 

VI. What keeps people from being well? (April) 

1. Accidents. 

2. Disease germs. 

3. Unhealthful work and surroundings. 

4. Bad habits. 

VII. Some personal and civic problems. (May) 



OUTLINE OF HEALTH STUDY FOR THE EIGHTH GRADE IN SPEYER 
SCHOOL, teachers' COLLEGE, NEW YORK. 

Mr. Ross. — I shall try to reserve my judo^ment until 
I have seen this publication. In the meantime may I 



io8 HEALTH AND THE SCHOOL 

ask why you have made no mention of physiology? 
Has it "gone out," too? 

Mr. Young. — Physiology presented as an isolated de- 
scription of the body and its functions has gone the way 
of Greek and certain forms of mathematics. It does 
not serve the purposes of a common school education. 
A detailed knowledge of physiology has about as much 
bearing on ordinary health practice as a mastery of cal- 
culus has on bookkeeping. Physiology as a separate 
study is a subject for specialists. If the high schools 
wish to offer a course in this subject they should make 
it elective. The limited amount of physiological infor- 
mation necessary to give force to the principles of hy- 
giene can easily be introduced as illustrative material 
in the study of the latter subject. 

It must always be remembered that the actual test of 
successful health instruction is not the passing of exam- 
inations on scientific textbooks. It is in the wholesome 
condition of the children. Clean teeth, skin, hair, nails, 
and clothes make up some of the evidence. New York 
City sets these items as its first requirements for credit 
in hygiene, which is now necessary both for graduation 
and for promotion from grade to grade. 

SEX INSTRUCTION 

As opposed to physiology there is a natural science 
which has generally been reserved for high schools and 
colleges, but which, in simplified form, can be brought 
down to the elementary grades with great advantage. 
This is the science of biology, which serves more ad- 
mirably than any other means to give children a sane 
and reverent attitude toward the supreme function of 
all living things, the imparting of life to others. In this 



HEALTH INSTRUCTION 109 

study, which begins with the simplest living forms, chil- 
dren come to realize deeply the wonder and the beauty 
of the universal natural provision for extending life 
through sex and parenthood. Such an attitude is essen- 
tial for a proper reception of the specific sex instruc- 
tion which the schools are beginning to recognize as 
their duty to offer. 

Preparation for family life and parenthood should un- 
doubtedly be one of the chief concerns of the school, 
and this responsibility rests in part, though not wholly, 
upon those responsible for health instruction. "Thus, 
in connection with lessons upon filial duty, self-respect, 
personal dignity, patriotism, obligations to posterity and 
to the race, conscience, purity, and religion, the facts of 
sex life have their proper place." * 

Mrs. Ross. — May I inquire as to the extent to which 
it is considered wise to carry sex instruction into 
schools ? 

Mr. Young. — That is a hard question to answer, Mrs. 

Ross, because much that is desirable to bring into the 

schools is it not yet wise to introduce. Instruction by 

outsiders throws undue emphasis upon the subject; and 

few teachers at present have the experience and training 

or the natural fitness to carry out the delicate task of 

leading children to think frankly and wholesomely about 

sex matters. That does not mean for a moment that we 

may not yet develop teachers fit for this task. The normal 

schools have a great responsibility in this matter. It is 

within their power to fill the schools in a few years with 

teachers who have the necessary information and the 

right attitude concerning sex facts to be helpful guides 

to growing children. Until such teachers are generally 

provided for our schools, however, it will be impossible 

* C. R. Henderson, Education with Reference to Sex. 
9 



no HEALTH AND THE SCHOOL 

to lay down any set program for such instruction. As 
much harm may come from forcing it as neglecting it. 
At present each school system will have to be guided by 
its own limitations and opportunities, bearing in mind, 
of course, constantly the program that, under ideal con- 
ditions, should be carried out. 

As to what this program should contain, there is a 
fairly general agreement among our educational leaders 
who have seriously studied the question. This is well 
summarized in a set of recommendations sent out by the 
Society of Sanitary and Moral Prophylaxis. These are 
as follows : 

ITEMS WHICH SHOULD BE INCLUDED UNDER SEX INSTRUC- 
TION 

Every boy and girl has a claim to knowledge : 
(i) Of the functions and hygiene of the chief organs of the 
body, including the reproductive system. 

(2) Of the meaning of sex, marriage, home-making, of the 
sacredness of the prenatal life, the influences of heredity and the 
consequent duty of right living, even when young; of the re- 
sponsibilities of parenthood. 

(3) That handling the organs of reproduction, except as 
necessary for cleanliness, injures sometimes health and always 
mind, character, and sense of honor, causing greater mental and 
moral harm as one grows older. 

(4) Of the most prevalent contagious diseases, such as tuber- 
culosis, syphilis, gonorrhea; their danger as indicated by stat- 
istics of wide prevalence ; their many methods of communication ; 
including the fact that syphilis and gonorrhea exist almost 
universally among those leading immoral lives ; a reason for 
avoiding such men and women as one avoids those with diphtheria 
and smallpox ; that they are more difficult to cure than any other 
contagious disease and that their harm is more far-reaching. 

(5) Of the normal phenomena of adolescence; the physi- 
ologic influences on health, mind and morals of clean thoughts, 
reading, conversation, entertainments, companions ; the value of 
occupation and physical exercise in keeping thoughts and habits 



HEALTH INSTRUCTION iii 

and health good ; the avoidance of tobacco, alcoholic drinks (in- 
cluding patent medicines, many containing alcohol), the adver- 
tisements of "doctors" and "remedies" found in newspapers, 
magazines, etc. 

Every girl has a claim to instruction concerning the hygiene 
of menstruation, the function and sacredness of motherhood and 
the care of infants. 

Every boy has a claim to instruction concerning the value of 
conscience, and avoidance of ignorant and evil advisers in this 
matter; the sacredness of fatherhood, and the duty of protecting 
all girls and v^^omen from evil as he would his sister or his 
mother. 

The physiology and hygiene of sex, when successfully taught, 
is an essential part of the course where it logically belongs. It 
must not be interjected. 

Mr. Martin. — I must say that this list of items strikes 
me as a rather overwhehning array of facts to set before 
our children. Must we part with all idea of youthful 
innocence ? 

Mr. Young. — Have you any idea how many of our 
public school children over eight or ten are youthfully 
innocent? Probably not one in twenty. They know the 
things they should not know and they don't know the 
things they should. Can the school any longer evade 
the responsibility of directing their natural and irrepres- 
ible interest in sex matters along proper channels? 

Miss Parsons. — We must bear in mind that if chil- 
dren do not get proper sex instruction in the elementary 
schools, 93 per cent, of them are likely to get it nowhere. 
The elementary school is the only school that this vast 
majority of American children ever attend. 

HOW TO MAKE SEX INSTRUCTION COUNT 

May I add a word also about the program for sex in- 
struction which Mr. Young has just read. It perhaps 



112 HEALTH AND THE SCHOOL 

seems somewhat bald and over-emphatic with regard to 
the repulsive and negative side of the subject. This side 
cannot be ignored, of course, but it need not be unduly 
emphasized and indeed, as I happen to know, it was far 
from the intention of those who framed this program 
that it should be. The matter of emphasis is in the hands 
of the teacher as is also the entire success of such a pro- 
gram which requires to be carried out with careful wis- 
dom. . In order to succeed, the teacher must be con- 
stantly guided by two fundamental considerations. The 
first is that high and beautiful ideals, such as are most 
vividly embodied in some hero, are far stronger incen- 
tives to right action than anticipated punishments. The 
pathology of sexual misdeeds should accordingly not re- 
ceive as much emphasis as should the high satisfaction 
and honor which come from following a difficult but 
self-respecting course. The second consideration is that 
injunctions as to right conduct cannot possibly result in 
right conduct unless opportunity is given to carry them 
out. A course of action must accordingly be opened to 
boys and girls which will make it possible for them to 
put into operation the difficult instructions that have been 
laid upon them. 

If girls are told to guard their health during menstru- 
ation, the schools must help them do it by relaxing de- 
mands of attendance and preparation of lessons when 
necessary. If boys and girls are instructed to be modest 
and restrained in each other's presence, the schools must 
give them the chance to meet and practice those virtues 
in parties and dances held under favorable auspices. 
Many schools in New York City and elsewhere are al- 
ready doing this for their young people. If boys are ad- 
vised to check their sexual desires they should be pro- 
vided with other exciting outlets to their growing ener- 



HEALTH INSTRUCTION 113 

gies. Wholesome fads of all kinds, such as airships, 
electrical experiments, boat-building, and photography, 
should be encouraged by the schools, in addition to the 
valuable standby, athletics. 

COOPERATION OF PARENTS NECESSARY 

Dr. Latta. — Making such wholesome provision for 
boys and girls as you indicate gives an opportunity for 
the closest kind of cooperation between school and home. 
There is no point in health instruction or moral instruc- 
tion — the two are inextricably associated — where it is 
so indispensable that the efforts of parents and teachers 
shall be mutual. Parents are unable to meet the respon- 
sibility alone — so are the schools. Parents, as a rule, 
are not well enough informed themselves to give their 
children all the instruction they need ; on the other hand, 
the schools cannot know as parents can when individual 
inquiries as to sex facts begin. 

The first question very certainly marks the time for 
the first instruction, which should be given frankly, ten- 
derly, but briefly by parents in prompt answer to specific 
questions put spontaneously by their children. It is not 
at all necessary to go into physiological detail in the 
early years. Children do not demand this, but they do 
insist on having the fundamental mysteries cleared. If 
they cannot persuade their parents to enlighten them 
they go to the turbid fountain of information, the street, 
where they acquire the most sacred facts of Hfe in a 
solution of poison. Definite school instruction even in 
the first grade cannot be sure of anticipating street in- 
struction. The cooperation of parents in this matter is 
vital. It is necessary that they end once for all the 
sense of forbidden mystery which at present makes 



114 HEALTH AND THE SCHOOL 

school instruction in the physiology and hygiene of sex 
a self-conscious and uncomfortable thing. 

Mrs. Ross. — How are parents to be persuaded to 
break their habitual silence on these matters? 

Dr. Latta. — We cannot hope, I suppose, to revolu- 
tionize the practice of all those who are now parents, 
though parents' meetings with frank instruction and dis- 
cussions have already resulted in a partial change of 
sentiment. Many fathers and mothers are beginning to 
appreciate the wonderful opportunities that the first in- 
nocent inquiries offer them for cementing the love and 
confidence already existing between themselves and their 
children; and, on the other hand, to realize the grievous 
blow which they strike both at themselves and their chil- 
dren if they repulse the childish confidence which 
prompts the early questionings. 

Before a complete change in parental feeling can be 
effected, however, a new generation of parents must be 
reared, and this fact gives the schools a present respon- 
sibility of double weight. 

For the best thought on sex instruction, which com- 
bines a rare ideality with a close practical knowledge of 
needs and methods, I recommend to your further study 
Professor C. R. Henderson's report on Education with 
Reference to Sex.* 

ESTABLISHING HEALTH HABITS 

Mr. Young. — Miss Parsons' appeal for the school to 
afford means for boys and girls to practice the moral 
and hygienic precepts they have been taught brings us 
to the question of how to convert health instruction into 

* Eighth Year Book, Part II, of the National Society for the 
Study of Education. 



HEALTH INSTRUCTION 115 

health habits. To do this successfully we must recog-- 
nize the three forces which are most powerful in direct- 
ing conduct, and consequently in establishing- habits. 
Briefly stated, these are (a) example, (b) motive, (c) 
continuous practice. The teachers and parents who do 
not constantly heed these fundamental springs of action 
will not proceed far in their critical task. 

Example. — Dr. Latta startled me last week by telling 
me that if I wanted the school children to stand straight 
I'd have to stand straight myself. I had inadvertently 
failed to apply what I knew well enough, that example 
was the most potent of all educational influences. Al- 
though we hear much rhapsodizing about the true edu- 
cation being an unfolding from within, and a leading 
out (e-ducing) of one's inner gifts, the fact remains 
that education is largely a laying on from without, and 
a drawing in to one's self of the knowledge and ways 
of ethers. 

Since this process is the main business of the forma- 
tive years, it is a most fortunate coincidence that chil- 
dren want more than anything else to be as other people 
are and to do as others do. Their natural tendency to 
imitate other people is immensely increased by admira- 
tion, and when children are lucky enough to admire their 
parents and teachers they strive to imitate these heroes 
and heroines in every possible way. All the personal 
tricks are faithfully reproduced, posture, breathing, 
chewing, smoking — in fact, every act on which the ob- 
servant youngsters can get any data. While this ten- 
dency is in full swing parents and teachers have no diffi- 
culty in persuading children to adopt healthful habits 
if they show their own respect for them by consistent 
observance. 

Mr. Ross. — That puts a mighty burden of responsi- 



ii6 HEALTH AND THE SCHOOL 

bility on us all, doesn't it? Must our children's desirable 
habits be limited to those they see us practicing? 
Haven't we a right to expect the new generation to be 
an improvement on the last? If not, how does social 
evolution operate? For instance, it is too late for me 
to make over my own habits of eating, but I don't in- 
tend to have my children bolt their food as I do. 

Mr. Young. — You have expressed very frankly an 
attitude of parents and teachers that is a perpetual 
stumbling block to children and that keeps social evolu- 
tion from operating more rapidly than it does. Parents 
and teachers are not necessarily finished human products. 
Should not they and their children struggle on, hand in 
hand, to conquer the difficulties and win the rewards of 
life? 

Mr. Martin. — If, among the difficulties, you include 
that of thorough mastication, I can commend Mr. 
Young's plan. We have adopted chewing reform in 
our family with pronounced success. My sister and I 
entered into the game with the children, and we all vied 
with each other in making record chews. It is far sim- 
pler to socialize a reform like this, making it a family or 
class effort, than to attack the difficulty individually. 
Our youngest child, it is true, was now and then careless 
about the rules of the game, but one punishment, an 
impressive one, was all the help he needed. He was not 
allowed to finish his supper. Though he was almost 
through with it, the effect was as thorough as starva- 
tion. He has been our star chewer ever since. 

Mr. Young. — The measure which impressed Mr. 
Martin's small son with the advantage of mastication 
illustrates the second influence we noted as leading chil- 
dren to form good habits. 

Motive. — If a dog performs his trick nicely you give 



HEALTH INSTRUCTION 117 

him a caress or a biscuit. By a system of rewards and 
discouragements you easily lead him to acquire all kinds 
of habits, which are known to you as tricks and to him 
merely as certain evolutions that bring about desirable 
results. 

This simple and thoroughly effective method of estab- 
lishing habits works just as well in the school or home 
as in the kennel. Children, like dogs, have a prefer- 
ence for doing things that are worth while. When they 
once become convinced that healthful habits are desir- 
able they will practice them to the end of their days. 

Mr. Ross. — Now what do you mean by desirable? 
It seems hardly fair to use arbitrary punishments and 
rewards to induce children to form good habits. If good 
and bad habits don't bring their own rewards and pun- 
ishments in good health and ill health, what do they 
amount to at all? 

Mr. Young. — To be sure. Children should be led 
as soon as possible to realize the tremendous profit that 
healthful habits yield, but before they are old enough to 
appreciate this they sometimes require very tangible evi- 
dence. A three-year-old hasn't had enough scientific 
training to realize the causal relation between imperfect 
chewing and dyspepsia. When he is deprived of his 
supper, however, he meets a concrete and instructive 
experience which is a symbol of what actually happens 
to some extent to every food bolter. 

Such expedients are, of course, necessary only in the 
very early years. Children are soon able to appreciate 
the priceless blessings that good health confers — beauty, 
prowess, fun, usefulness, earning capacity, friendship, 
happiness. This list makes a powerful appeal to grow- 
ing boys and girls, who do all in their power to win 
such prizes when they believe they know the way. 



ii8 HEALTH AND THE SCHOOL 

The Speyer School plan of hygiene instruction takes 
full account of these social motives. It is qualified at 
every step to arouse a desire on the part of children to 
keep themselves and their surroundings wholesome. I 
am confident that we cannot do better than to adopt a 
similar method for use in our schools. 

For the present, however, I believe we need to sup- 
plement this general plan with a certain amount of in- 
tensive work on health subjects. Since the Speyer 
School course is developed as a unit from the kinder- 
garten to the eighth grade, it will evidently be many 
years before all our children are able to receive the full 
benefit of such a course. It therefore has seemed es- 
sential that for a time we provide more special and 
striking opportunity for health study, so that the older 
children may not leave school without having gained 
a clear impression of its immense importance. 

The special program which we have already intro- 
duced takes account not only of pupils, but of parents 
and teachers, among whom it is highly necessary to 
arouse a new interest in health matters. A serious and 
practical attitude toward these concerns, I regret to say, 
is a rather new thing for us all. It is, therefore, highly 
important that we direct widespread, earnest, and im- 
mediate attention to them. The only way to do this is 
to disregard temporarily certain ideal pedagogical con- 
siderations and frankly resort to successful advertising 
methods. This is exactly what we are doing. 

Our problem is to make all our children and their 
teachers and parents see as promptly as possible that 
wholesome habits are desirable. The only way to do 
this is to prove it to them. Lectures, exhortations, and 
pictures of drunkards' stomachs do not prove anything. 
Demonstrations do. Therefore, we are demonstrating. 



HEALTH INSTRUCTION 119 

We are using our schoolrooms now not merely as lecture 
halls for teaching hygiene, but as laboratories, and the 
children themselves are serving as their own subjects of 
experiments. 

Our first step was to take the pupils and their parents 
into our plan and make them see what a valuable thing 
it would be for us all to find out surely whether hygienic 
habits bring about the good results that are claimed for 
them, and we showed them further that schools of sev- 
eral hundred children each furnish the best possible 
means for making such an investigation. As a first 
step we asked the children with the help of their par- 
ents to fill out forms, setting down their daily physical 
habits, their hours of sleep, frequency of baths, opening 
of windows at night, thoroughness of mastication, tea 
drinking, cigarette smoking, etc. 

Both children and parents responded to this request 
with surprising promptness and earnestness. When the 
reports were all in we held a few early evening meet- 
ings for both parents and children, at which physicians 
gave short talks on the laws of health. We then ex- 
plained that we wished, if possible, to establish the value 
of each one of these health laws, and that in doing 
this we should be greatly aided if every child who was 
found to be neglecting any of them would, with the 
aid of his parents, correct some single practice desig- 
nated by his school principal. Consent to this plan was 
heartily given and the experimental work began. 

On the basis of their reports the children were formed 
into groups, according to the single habit which varied 
most widely from standard. The flagrant tea drinkers, 
the short sleepers, the food bolters, even the cigarette 
smokers, agreed respectively to reform their one worst 
habit, leaving the other habits unchanged during the 



I20 HEALTH AND THE SCHOOL 

time of experiment (six weeks). I may say parentheti- 
cally that in rounding up the cigarette smokers we 
did not depend entirely on their own confessions. A 
little judicious detective work arranged between teach- 
ers and parents had been necessary both for discover- 
ing the smokers and for holding them to their prom- 
ises. One boy, who disregarded his promise, immedi- 
ately lost his place among the army of investigators. 
The school sentiment was so overwhelmingly against 
this deserter that no one has since ventured to break 
training. The children are immensely in earnest and 
will tolerate no insincerity or "faking" among their num- 
ber. 

Mr. Martin. — How are you expecting to show the 
benefits resulting from this six weeks' experiment? 

Mr. Young. — By two series of measurements taken 
at the beginning and at the end of the six weeks. These 
measurements include weight, height, lung capacity as 
tested by the spirometer, and nervous energy as indi- 
cated by a hand dynameter. 

These methods of testing the children's physical con- 
dition have been chosen because they are thoroughly 
practical for dealing with large numbers. They are 
somewhat crude, of course, and even with our closest 
care will doubtless permit a certain amount of error to 
appear in our results. It has already been a little dis- 
concerting to observe that some members of our "mas- 
tication squad" have lost weight since they began to 
chew more thoroughly, and that a few of our tea drink- 
ers are showing increased nervousness since they dropped 
their tea. These cases are due to exceptional causes, 
however, such as sickness, toothache, and domestic up- 
heavals of various kinds. They will not seriously mar 
the success of our experiments, since the number of chil- 



HEALTH INSTRUCTION 121 

dren taking part in them (5,000) is large enough to 
make an average result contain but a small percentage 
of error. The children understand that they cannot ex- 
pect to see a miracle performed in every child or in 
every class. They are accordingly waiting with great in- 
terest for the returns from the other schools, where chil- 
dren of the same age are cooperating in the same experi- 
ment. 

Mr. Ross. — I must confess that Mr. Young's scheme 
strikes me as very interesting. I should fear, though, 
that the unusual excitement brought about in the schools 
by this novel experiment would entirely demoralize the 
ordinary school work. How has that been going for- 
ward since the "training" began? 

Mr. Young. — Your question brings up one of the 
most interesting facts in connection with this experi- 
ment. The school work during this time has been car- 
ried on with a vigor and enthusiasm quite unknown 
in my previous experience. Realizing that the health 
experiment, as long as it lasted, would be the consum- 
ing interest both in the schools and the children's homes, 
we have related most of our school work to it. First 
of all, we have provided for a considerable amount 
of direct study of hygiene, based on recent excellent 
textbooks in that subject. In addition to this, the other 
studies have all been connected with the present pre- 
vailing interest of the school. The arithmetic work has 
been based upon the numerical aspects of the laws of 
health, such as amounts and proportions of food and 
hours of sleep, and upon tabulations and calculations of 
the various measurements made on the children. Much 
of the actual measuring and recording has, in fact, been 
performed under supervision, by the children themselves. 
The reading and composition work has centered on 



122 HEALTH AND THE SCHOOL 

health matters, and even the history and geography have 
been brought into hne by being made the occasion for 
studying the Hving conditions of other times and cHmes. 

It is the first time we have ventured in our schools 
to depart from formal tradition and to carry out the 
modern idea that school work should be inspired by a 
vital and immediate motive. So successful is our ex- 
periment proving, however, that we shall later arrange 
some such general program for a thorough study of 
home, school, and town sanitation. 

We shall not confine this instruction to what the 
books declare ought to exist. We shall supplement such 
theoretical knowledge with a scrutiny of the actual con- 
ditions in our town, including our schools and homes. 
The children will look into the matter of how their own 
homes are ventilated ; they will find out whether their 
schools are cleaned by dry or wet sweeping; they will 
discover the mosquito-breeding places in their neighbor- 
hoods, and they will be made responsible, whenever pos- 
sible, for looking after certain sanitary details in their 
homes and schools and neighborhoods. 

They will study public sanitation by seeing how the 
trolley cars in which they ride are ventilated, how the 
town streets are cleaned, how the color of the water in 
the river changes at the points where the sewage flows 
in ; and by comparing local sanitary provision with the 
best methods in use elsewhere for securing the people's 
health. They will learn what "bacterial count" means 
and how it indicates the purity of our water and milk 
supplies. They will conduct bacterial experiments them- 
selves, and see how the conditions of our milk and water 
compare with safe standards. Some of the children will 
make excursions to the filter plant of the neighbormg 
town and bring a report of it to their schoolmates. In 



HEALTH INSTRUCTION 123 

a hundred ways they will learn what sanitation really is 
and how it pays. 

Mr. Ross. — This is all very excellent, but it seems 
to me that you have made an unwarranted assumption 
in taking for granted that children really value health 
much, and that they will adopt sanitary practices when 
they are convinced that these will result in health. They 
certainly will not if they are like my boy. His health 
is the last thing he ever thinks of. Except as his mother 
controls him, he is absolutely reckless of it, as indeed 
most boys are. 

Mr. Young. — I don't doubt it, but it is not because 
he doesn't like to be well. When the actual possibility 
of pain and disease confronts children their bravado van- 
ishes. Have you ever seen a panicky youngster holding 
his breath, gallop by a quarantined house in mortal fear 
that a germ would catch him? Children do not need 
to be convinced that health and strength are things they 
want. Their skepticism is usually directed against the 
means for securing these blessings. 

In impressing the desirability of health habits on the 
children we are not confining their attention to the 
profits they themselves derive. We are making it clear 
to them that the benefit is shared by many others, those 
in their families and schools, and, in fact, the whole 
town. They see that the less sickness each child has, 
the less of the family income melts into the hands of 
the doctor, the less the work of his class is interrupted, 
the less strain and possible sickness his mother and 
brothers and sisters and neighbors suffer. 

The moral obligation of keeping one's health, the chil- 
dren are discovering, is as soundly based as that of any 
other virtue. Truth telling and honesty are accounted 
virtues merely because they contribute to the general 



124 HEALTH AND THE SCHOOL 

good. Individual good health, they see, contributes to 
the general good no less than these. To fail in health 
when others depend on you is to break a promise; to 
spread contagion is to steal. Good health, like honesty, 
is the best policy. 

Continuous Practice. — The best examples and the 
most powerful motives, while they are effective aids in 
initiating habits of health, are not always sufficient to 
fix them. There is only one swift, sure way to do this. 
I will ask Miss Parsons to discuss it. 

Miss Parsons. — Parents and teachers who really 
want results must resort on occasion to the military 
method of obtaining them. They must not allow lapses 
in conduct. 

Mr. Martin. — But how can they prevent occasional 
lapses? Children aren't under observation all the time. 

Miss Parsons. — They ought to be. 

Mr. Ross. — What ! Do you mean that our poor chil- 
dren are never to have any rest from supervision, or 
the patient teachers and parents from incessant super- 
vising? 

Miss Parsons. — You put it rather unsympathetically, 
but that is just what I mean. A thoroughbred race 
horse is never left to his own devices. He is too valu- 
able a creature. What about a child? Until he has ac- 
quired a reliable bent it is the most reckless folly to turn 
him absolutely loose. An hour of unsupervised play 
can make mischief for a lifetime. 

Mr. Martin. — Your idea is so novel that I hardly 
grasp it. Do you actually mean that all children, rich 
and poor, should be watched and guided all the time? 
Do you believe for a minute that such an arrangement 
is possible? Working parents cannot keep their eyes 
on their children much of the time, and, as for the 



HEALTH INSTRUCTION 125 

teachers, they already have more work than they can do 

Miss Parsons. — Let us have play leaders, then. 
There are various ways of giving children more super- 
vision than they now have. Lengthened school hours, 
which provide for directed play as well as work, super- 
vised playgrounds and recreation centers, these all tend 
to increase the time that children are wholesomely em- 
ployed under responsible guidance. 

Mr. Martin. — I find it hard to give up the idea that 
the rough and tumble treatment which children give 
each other free from their elder's scrutiny is the best 
part of their education. 

Miss Parsons. — That cherished conviction is very 
widely held, but it has no basis in fact. Unsupervised 
play among boys of different strengths always crowns 
the bully who has the muscle to support his claims. It 
is also in their unwatched moments that children give 
each other liberal instruction in vice, which is a part 
of almost every public school child's present education. 

Mr. Martin. — I fear that this is undeniable, and yet, 
won't all this supervision take the spontaneity out of 
our children? 

Miss Parsons. — Far from it, if the supervision is of 
the right sort. A good play leader encourages all the 
wholesome impulses of children. By enforcing fair 
play he actually liberates unsuspected powers in the 
more timid children, who would stand no chance at all 
in the* free for all scramble of unsupervised play, 

Mrs. Ross. — Children's play has an effect on character 
no less marked than upon physique, and if we do not 
make sure for the children that their play shall be right- 
minded and friendly as well as physically safe, we may 
be wronging them more deeply than if we were to ex- 
pose them to physical danger. In Gary, as you remem- 
10 



126 HEALTH AND THE SCHOOL 

ber, the schools and grounds are open under supervision 
all day for the special purpose of saving the children 
from the demoralizing street and alley. The Gary chil- 
dren so far have lost none of their spontaneity, but they 
have been spared a great deal of viciousness and cigarette 
smoking. 

Mr. Young. — Our discussion seems to have wandered 
to the question of enforcing moral as well as health hab- 
its, but after all, these two sets of habits are intimately 
associated. The method of enforcement, eternal vigi- 
lance, is the same for each. When parents wake up to 
the truth that habits, not half-forgotten facts, are the 
actual fruits of education, and that children's habits are 
being formed every minute of the day, they will manage 
to work out some plan whereby every one of these min- 
utes shall be wholesomely directed. 

In closing, let me call your attention to the valuable 
training in health habits that is being carried on through 
the Public School Athletic League in New York. Ten 
thousand school boys in the spring of 1913 were prepar- 
ing to take part in the great demonstration of the league 
to be held in June. To a man, they voluntarily adopted 
and rigidly kept the following set of health rules : 

Go to bed at 8 P. M., after a thorough wash. 
Scrub the teeth and gums thoroughly. 
Have your clothes and books ready for the next day. 
Keep your bedroom windows open top and bottom. 
Rise not a minute later than 7 A. M. ; take two minutes for 
drill and hygienic exercise. 

Clean face and neck and scrub hands. 

Finish with a cold splash all over. 

Rub yourself hard all over. 

No cofifee ; no tea ; drink milk, a little at a time. 

Chew your food to a pulp. 

No smoking. 



HEALTH INSTRUCTION 127 

Then look yourself over and ask yourself: Am I clean from 
head to foot? Do I stand up like an athlete? 



Suggested Reading 

American School Hygiene Association. Proceedings 
OF the Third Congress. The Problems of Hygiene 
and the Province of the Normal School. 
The Teaching of Hygiene. 

Proceedings of the Fourth Congress. New Principles 
in the Teaching of Hygiene, The Teaching of Sex 
Hygiene. 

Proceedings of the Fifth Congress. The Consecra- 
tion of the Affections, Often Misnamed Sex 
Hygiene. 

Some Suggestions for a Course of Study in Hy- 
giene. 

Denison. Helping School Children, pp. 233-246. 

Health Education League. Health Education Series. 

Journal of Educational Psychology. Hygiene Num- 
ber, October, 191 1, 

Nature Study Review. February, 1910. 

Teachers' College Record^ May, 1912. 



VIII 

HEALTH SUPERVISION IN SCHOOLS 

Mr. Young. — In 1890 the little western city of San 
Antonio established a system of so-called school medical 
inspection. Four years later Boston, with its neighbor- 
ing towns, Brookline and Cambridge, took this step. In 
1902, twenty-three cities had taken it; in 1912, four hun- 
dred and forty-three cities were conducting some form 
of medical inspection * and in 1913 it is estimated that 
eight hundred cities were doing this. The health super- 
vision movement is sweeping the country, and is about to 
capture our own town. 

The work which our club has been directing for the 
health of the school children has aroused the citizens, 
and they are demanding that public measures be taken 
for accomplishing in all the schools what we have done 
experimentally in two of them. 

These measures cannot be arranged overnight. We 
must plan them with closest care if we would escape the 
blunders already made by scores of cities which have 
rushed uninstructed into the health business. While 
health supervision is a vital improvement that has come 
to stay in the schools of our country, it has not yet 
passed the experimental stage. It has still no general 
standards. Each city evolves its own method, which is 

* What American Cities Are Doing for the Health of School 
Children. — Russell Sage Foundation. 

128 



HEALTH SUPERVISION 



129 

12 



10 



09 



08 



07 



06 



05 



02 nn 



1 4 5 8 9 11 17 23 28 37 55 77 111 167 263 400 411 443 
THE RISE OF SCHOOL HEALTH SUPERVISION. 

often SO inadequate that its chief benefit seems to be 
the air of progressiveness which its name imparts to the 
town. 

A preliminary survey of this field has been made by 
Miss Parsons. We shall hear her report to-night. 

Miss Parsons. — Without in the least discrediting the 
health supervision movement, I must admit that the 
fruits it has so far borne are not yet commensurate with 
the stir it has made. The towns we have visited have 
displayed a wonderful variety of systems which, with 
a few most hopeful exceptions, are so rickety that they 
would not be tolerated at all under any private business 
management. The main trouble is that most health su- 



I30 HEALTH AND THE SCHOOL 

pervisors have not yet found out just what they want 
to do or how they want to do it. Their program is 
vague; their methods more so. 

There is only one proposition on which all are united. 
No one disputes that the purpose of health supervision 
is to promote the health of school children. From this 
point on we encounter amazing divergence. There are 
no generally accepted standards of what constitutes 
health in school children ; of what are the best means 
of preserving and building up their health ; or of restor- 
ing it when impaired. Such problems of technique have 
been largely overlooked. 

Notwithstanding this temporary maladjustment be- 
tween purpose and method, the prospect for sound health 
supervision throughout the country is bright. Within 
the year all our largest cities have made distinct ad- 
vances in the efficiency of their systems, and here 
and there, in various states, smaller cities and coun- 
try communities have forged out excellent devices 
for meeting special problems. By coordinating the 
best experience thus far available we shall be 
able to establish a very effective system for our own 
town. 

To-night's discussion will be devoted to our projected 
health supervision program; our next discussion will be 
given to the best methods of carrying it out. 

The general aim of health supervision in schools is 
to guard and develop the health of pupils. The means 
for carrying out this aim are fivefold : 

1. Medical inspection, examination, and aid. 

2. Sanitary supervision of school buildings and homes. 

3. Hygienic regulation of school and home activities. 

4. Health instruction of pupils and parents. 

5. Physical education of children. 



HEALTH SUPERVISION 131 



MEDICAL INSPECTION^ EXAMINATION, AND AID 

The distinctively medical division in a system of health 
supervision should be responsible for the standing as well 
as the progress in health of all pupils. To this end, it 
must provide for the periodic physical examination of 
pupils in order to determine what form of physical de- 
velopment or corrective treatment they may require. It 
must also provide for inspection for contagious disease 
at stated intervals, as well as at such other times as cir- 
cumstances may call for, and it must fix and enforce 
quarantine in cooperation with the board of health. 
Finally, it must not only keep a thorough current record 
of the health condition of all pupils but enforce and pro- 
vide, when necessary, the proper treatment of all disease 
and removable defects discovered. 

The necessity for guarding against contagious dis- 
ease in schools is so apparent that, when a school sys- 
tem begins to take any special measures for its chil- 
dren's health, its first step is invariably to establish some 
form of inspection for such disease, the main purpose 
being to discover each case as promptly as possible in 
order to exclude it from school. 

The motive of such inspection work is merely commu- 
nity protection, and is not based upon a concern for the 
sick children themselves. This necessary precautionary 
work is as much as many systems up to the present have 
undertaken. 

Some cities, however, recognizing the need of attend- 
ing to the individual health of children, now require, in 
addition to the regular inspection service, a partial or 
thorough examination of every school child, to deter- 
mine his state of health and development. A little more 



132 HEALTH AND THE SCHOOL 

than half of the cities which require examinations are 
satisfied with a record of eye and ear difficulties. 

The examination work that we have done experi- 
mentally in our own town has left us in no doubt, how- 
ever, of the tremendous importance of finding, with a 
view to their correction, all the chronic defects which 
are handicapping our children. The need of correcting 
the defects thus discovered, and, indeed, of treating 
properly all illness, slight or serious, which affects school 
children, indicates the third demand that rests on the 
medical division of a health supervision system. This 
is either to arrange for or actually to give medical, surgi- 
cal, and dental treatment to all the children who need it. 

Mr. Martin. — Aren't you talking revolution. Miss 
Parsons? If there is one regulation on which our com- 
mittee has found practically all medical supervision sys- 
tems united, it is the emphatic order that school physi- 
cians shall not only give no treatment, but offer no 
advice as to treatment. 

Miss Parsons. — ^Was there ever a more short-sighted 
policy? Why waste these doctors so? The one big 
thing that most of them are as yet trained to do is to treat 
disease. All the medical schools still lay their chief stress 
upon this function. Why should we deprive the doctors 
of opportunities for service, compelling them to eke out 
their incomes by doing nurses' work — you will see next 
week that inspections and, to some extent, examinations 
are nurses' work — when the best use they can make of 
their time at present is to treat the school children? 

Mr. Ross. — Would not such a course tread on the toes 
of the family physician? 

Miss Parsons. — That is one of the theories, to be 
sure, on which school treatment is so vehemently op- 
posed, but the theory doesn't hold water. It has been 



HEALTH SUPERVISION 133 

overwhelmingly demonstrated, in our country and 
abroad, that private practitioners are not called upon 
widely to treat school children, even when the schools 
have discovered the need. 

Dr. Latta. — We must admit, however, that New 
York City in 191 1 made an exceptional showing in this 
regard. Fifty-eight per cent, of school children treated 
there received treatment at the hands of private physi- 
cians, the remaining forty-two per cent, depending on 
hospitals and dispensaries. 

Miss Parsons. — But even when private doctors are 
extensively called upon, which is not often, a large pro- 
portion of them leave the children in worse condition 
than they found them. Have the schools a right, do 
you think, to send the children off to practitioners who 
are likely to harm them ? 

Mrs. Ross. — What an extraordinary idea. Miss Par- 
sons. You have made an appalling statement. Does Dr. 
Latta hold the same opinion? 

Dr, Latta. — Unfortunately, I do. The fees that physi- 
cians receive are, to some extent, an index of their com- 
petency. Can you expect a man who earns his living by 
making bedside visits for twenty-five cents to handle 
cases as competently as the two or three-dollar man ? 

Mrs. Ross. — But the poor can't pay more for medical 
service for their children. 

Dr. Latta. — Exactly, but can society afford to let the 
majority of its young citizens — the poor are always the 
majority — depend upon the kind of medical treatment 
poor parents can afford? 

Miss Parsons. — Fortunately, perhaps, the poor par- 
ents, as we stated, do not call widely on private physi- 
cians when their children's defects are discovered. Dis- 
pensaries and clinics of some kind must invariably be 



134 HEALTH AND THE SCHOOL 

pressed into service to secure anything like an adequate 
amount of treatment for the mass* of school children. 
The confusion, delays, difficulties, and often the impos- 
sibility of providing treatment in such institutions which 
are under the supervision of neither school nor health 
board, make the arrangement extremely unreliable. On 
the whole it has proved a failure. 

A medical inspection and examination system that, 
in spite of proved experience, continued to trust to the 
hazardous cooperation of outside agencies or irrespon- 
sible physicians for carrying out its own recommenda- 
tions comes pretty near to being a farce. Most of the 
systems in our country, until very lately, have been of 
this order. If ours is to take higher rank it must pro- 
vide for the treatment as well as the examination of 
the children. 

Dr. Latta. — We shall not be absolute pioneers in 
such an undertaking. The schools are everywhere be- 
ginning to realize the necessity for providing prompt 
and proper treatment for pupils, not only for the benefit 
of the children, but for the sake of raising their own 
efficiency through the resulting improvement in the at- 
tendance and the energies of the children. True, not 
many American cities have as yet developed satisfac- 
tory arrangements for providing treatment, but the 
number of those making a start in this direction is in- 
creasing every day. The day is even now in sight when 
school dispensaries will be general. 

Miss Parsons. — The largest cities are already pro- 
viding nurses' rooms, where slight accidents and ail- 
ments are treated by the nurses. This arrangement 
alone is an immense advantage to the schools, obviating 
as it does the necessity of wholesale exclusion for minor 
contagious diseases, which formerly were a fertile source 



HEALTH SUPERVISION 135 

of truancy and often resulted in the complete demoral- 
ization of the school. In New York City, school exclu- 
sions have been reduced from 57,000 in 1903 to slightly 
over 3,000 in 191 1, and this in spite of the great in- 
crease in the number of school children in that time. 
Forty-eight cities have school dentists and a few have 
dental nurses whose business it is to give prophylactic 
care to the children's teeth. New York City is conduct- 
ing eye, ear, and dental clinics and is considering the es- 
tablishment of dispensaries for the treatment of other de- 
fects. A few cities, among them Los Angeles, as you 
remember, are conducting polyclinics where all non-in- 
fectious ailments and defects can be treated. The tech- 
nique of the whole problem of children's clinics and dis- 
pensaries has been well worked out both in Europe and 
in our own country.* 

Mrs. Ross. — You would not, I suppose, advocate com- 
pulsory school treatment? 

Miss Parsons. — Certainly not, unless parents failed 
to secure necessary and satisfactory private treatment 
for their children. The determination by the school au- 
thorities of what may be called satisfactory treatment 
is, of course, a matter for very wise adjustment. How- 
ever that may be arranged, I would at any rate advocate 
a more extensive follow-up system on the part of nurses 
than is commonly practiced. If it is worth while to 
follow up any case of sickness or defect, it is worth while 
to follow up every case. The little illnesses that ordi- 
narily pass off without the attention of a physician — ■ 
the short "bilious spells," the digestive upsets, the slight 
colds, the headaches — all of which play havoc with 
school attendance and school work, should be subjects 
of special attack on the part of the school nurse, who 

* Medical Inspection of Schools, Chapter XV. A. H. Hogarth. 



136 HEALTH AND THE SCHOOL 

can do much by tactful home instruction to prevent 
their future occurrence. The more serious cases should, 
of course, also be recorded, and the school authorities 
satisfied through the inspecting nurses that proper treat- 
ment is being provided. 

Mr. Ross. — Are you not introducing too much pa- 
ternalism into your system? 

Miss Parsons. — No paternalism at all, Mr. Ross. 
Would you say that our democratic system of public 
education is paternaHstic ? Why, then, should you regard 
the enforcement of health as a less democratic procedure 
than the enforcement of learning? If the school is to 
carry out its essential purpose of developing useful citi- 
zens, it cannot afford to take any chance on their health. 
It is the business of the medical corps to see that no 
chances are taken. 

sanitary supervision of schools and homes 

Sanitary supervision of schools has for some time 
been recognized as an essential safeguard to the health 
of school children. It will not be necessary for us to- 
night to review the program of school sanitation, having 
discussed this at some length in an earlier meeting * 
I wish, however, to emphasize the need of fixing definite 
standards of home sanitation, and of extending the sys- 
tem of sanitary inspection to include homes as well as 
schools. 

Unless wholesome surroundings are to be regarded as 
luxuries merely for school hours, supervision of home 
sanitary conditions is fully as important as the super- 
vision of school conditions. Efforts to improve home 
conditions have already been made by visiting nurses 
* See Chapter III. 



New Britain 



Spotless Town Crusade ''^"conn:^ 

Does your back yard look like this? 




If so, why not clean up before Easter Sunday ? 



Dirty yards cause tiles, sickness, death. 
Old tin cans hold water; water breeds mosquitoes. 
Rotten garbage makes bad air, bad air makes weak 
bodies, weak bodies make big doctor's bills. 



What you can do to help make New Britain a Ciean City 

Take away all the ashes and dirt from your back yard immediately. Send 

your rubbish to the dumping ground. 
Clean out your cellars, stables and sheds. Whitewash your cellar walls, 

fences and hen-houses. 
Bum all rubbish that will bum. Clean your vacant lots and alleyways. 
Avoid mi.xing ashes and garbage. This is against the law. You may be 

fined five dollars. 
Refrain from throwing old paper, banana or orange skins into streets. 
Plant some grass and flower seeds to make your home beautiful. Every 

house should have a little green grass and a few trees. 
When you have cleaned up for Easter, KEEP YOUR YARD CLEAN ALL 

THE TIME. 
The Board of Public Works, City Hall Telephone 77, will furrish informa- 
tion concerning teams and dumps. 

This Is the Program 

April 8 to IS, Spotless Town Week; everybody clean up. 
April 9, Palm Sunday; all dirt from the winter carried away. 
April 14, Fast Dav, Holldav; all dirt carried away. 
April 16, Easter Sunday: let us make New Britain a city that is 

"AS CLEAN AS AN EASTER LILY " 

TOSEPH M. HALLORAN. Mayor. 
■dr. henry T. bray. Health Officer. 
AUGUST BERGSTROM. Sanitary Inspector. 
HERBERT A. JUMP. Sec'y of Spotless Town. 



CIVICS AND HEALTH. 



The "Spotless Town League," composed of ten thousand New 
Britain school children, distributed this appeal and enlisted the 
entire population of 45,000 in a clean-city crusade. The appeal 
was printed on yellow paper in six languages. 

137 



138 HEALTH AND THE SCHOOL 

and teachers in many communities, but such work has 
thus far depended largely upon voluntary personal zeal 
or the occasional appeal of an especially needy case. 
Home inspection should be put on as sure and system- 
atic a basis as school inspection; for the school has a 
right to know the home conditions of all its pupils, and 
to insist, either through its own authority or that of 
other public agencies — health boards, housing officials, 
or. nuisance inspectors — that the children's physical sur- 
roundings shall not fall below a minimum standard for 
healthy growth. The actual records of home and neigh- 
borhood inspections, including such items as the condi- 
tion of streets, alleys, and vacant lots, and the drainage 
of pools and gutters, can be made of great direct value 
to the school children by serving as practical material 
for their own study of hygiene and sanitation. 

In a number of towns children have been successfully 
enlisted in a town-cleaning crusade. They take great 
pride in bearing a recognized part ir; a real town move- 
ment. The beneficial effect both on the town and on the 
children is quite incalculable. In this connection the 
achievements of Mrs. Caroline Bartlett Crane, of Kala- 
mazoo, "the Mother of Spotless Town," are well worth 
consideration. The success of this remarkable woman's 
work is due as much to her ability to educate citizens 
in the purpose and methods of public sanitation as to 
the actual sanitary work which she directs in their towns. 

HYGIENIC REGULATION OF SCHOOL AND HOME ACTIVITIES 

Questions of the relation between health and the ac- 
tivities and conditions of school life as well as the 
home life of school children, present almost a virgin 
field of school health supervision. Certain items which 



HEALTH SUPERVISION 139 

belong under such general heads, as health of teachers, 
recess periods, and home study, have now and then re- 
ceived desultory attention, but these items and many 
others like them are fast shaping themselves into the 
whole general problem of securing a healthful round of 
twenty-four hours of activity, rest, and recreation for 
children. This is actually the most fundamental of all 
the questions involved in the health of children at school. 

When the contagious diseases are brought under con- 
trol, as they will be, and the school houses and homes 
cleaned up, as they will be, and a proper food supply 
secured, as it will be, the one great factor influencing 
the health of children will be the manner and conditions 
of their pursuits. We touched on a few of the most 
important matters under this head when we discussed a 
school child's day, the distribution of his hours of study, 
play, and rest, but our discussion, thorough as it 
seemed, dealt only with the fringe both of what is known 
and what is yet unknown in this comprehensive field. 

Though a hundred questions still wait for scientific 
determination, there are scores of facts thoroughly at- 
tested, which it should be someone's business to push 
through the hard-set doors of our schools. It is a fa- 
vorite pastime of school experts at present to contem- 
plate the unknown, and to formulate brilliant lists of 
questions still waiting answer in connection with the hy- 
giene of child life. It would be an even more brilliant 
exercise of their wits to secure the recognition of what 
is already known, and to make it the basis of school 
practice. 

Every one knows, for instance, that a cheerful, friend- 
ly schoolroom atmosphere is an essential condition 
for health, and that healthy, cheerful teachers are in- 
dispensable to this arrangement, and yet how many 



I40 HEALTH AND THE SCHOOL 

schools are taking measures to keep their teachers well 
and happy? Every one knows that it is an unnatural 
strain for little children to be kept sitting in repressed 
silence for hours every day, but the schools aren't let- 
ting up much on this curious method of developing citi- 
zens. Every one knows that work which gratifies the in- 
stinctive desires of children draws out their most joyful 
and vigorous endeavor, and yet the schools are either 
ignoring entirely or recognizing in very grudging mea- 
sure the passion of children for constructive work and 
dramatic expression, while continuing to ply them with 
premature formal studies that would later present a vital 
appeal and be covered in far less time, at far less cost 
of energy both to teacher and pupil. In short, every 
one knows that the highest physical well-being requires 
that work shall not only be free from strain, but a source 
of interest and joy ; and yet how many schools see to 
it that the yoke does not rub? How many are prescrib- 
ing work for little children according to its joy-giving 
capacity ? 

We need some authority in our schools to enforce the 
principles already known that relate to the healthful 
activities of children. 

Mrs. Ross. — It is a new thing to me, and most en- 
lightening, to hear these matters grouped together, as 
they evidently should be. Could you give us further 
items that come under the general head of hygienic 
activities ? 

Miss Parsons. — Plenty of them. Protection of chil- 
dren's eyes by every possible means — books printed on 
unglazed paper, in large, distinct type ; clean, unglazed 
blackboards on which large characters are used ; coarse 
writing pens and soft pencils ; the abolition of slates ; 
regulation of the amount of close eye work to fall short 



HEALTH SUPERVISION 141 

of the fatigue limit ; requiring of proper illuminating fa- 
cilities in homes ; protection from nervous fatigue by fit- 
ting school demands to individual capacities — allowing 
for physiological age, and the manifest aptitudes of chil- 
dren in the assignment of their work; separating chil- 
dren who show widely different rates of progress, thus 
removing a general and constant source of discourage- 
ment or irritation. Finally, persistent inquiry and in- 
vestigation as to matters not yet determined, such as the 
effect of long hours of sitting on heart action, of indoor 
school work on the number of red corpuscles in the 
blood, of hours of study on gain in weight. These are 
only a few of the vital questions which must be brought 
under regulation by experts in the hygiene of education. 

Mrs. Ross. — I don't see how our little town can hope 
to command the services of an expert able to speak with 
authority on all these critical matters. 

Miss Parsons.' — It ought not to be necessary for each 
little town to employ actual authorities on educational 
hygiene. If we can only be supplied with approved 
standards from an authoritative source, our local au- 
thorities can put them into execution. The best infor- 
mation on these subjects should be made available to 
all our schools by the state education department or 
the national bureau of education or the children's bu- 
reau. A number of our states which are most progres- 
sive in health matters are already doing valuable edu- 
cational work of this kind, issuing frequent bulletins to 
health officers, and holding health institutes ; but the in- 
dividual efforts of these states, however valuable they 
may be, are likely to be sporadic and variable. The 
standardization of educational hygiene is a national con- 
cern. The states require national guidance and help in 
this work. The Washington bureaus should focus the 
11 



142 



HEALTH AND THE SCHOOL 



knowledge that is being gained through our nation-wide 
experiments in the hygiene of education, and they should 
be equipped to give out to every school in the country, 
either directly or through state departments, authori- 
tative information as to the best standards achieved to 
date. 




LEGAL PROVISION FOR SCHOOL MEDICAL INSPECTION (1912). 

States in white have mandatory laws; shaded states have permissive 
laws, states in black have no laws at all. [From Russell Sage 
Foundation.! 



HEALTH INSTRUCTION OF PUPILS AND PARENTS 



A system of health supervision should include general 
oversight of the hygiene and sanitation that is taught 
to school children and their parents. The methods and 
details of such work should, of course, be developed 
with the cooperation of the educational staff of the 
schools, but it should be the special province of the 
health supervisors to give constant power and direction 



HEALTH SUPERVISION 143 

to this important instruction, which tends to become 
hopelessly weak unless it is under expert control. Teach- 
ers, owing to the character of their training, know less 
about hygiene and sanitation than about any other sub- 
jects they are expected to teach, and, until normal 
schools wake up to the need of giving generous train- 
ing in these subjects, health supervisors will have to 
make up the deficiency by supplying teachers with in- 
formation as well as enthusiasm. 



PHYSICAL EDUCATION 

The term physical education is often loosely used as 
applying to all the educational factors that affect the 
health of children, but it is more properly employed to 
mean the cultivation of physique as a basis for the 
highest possible vitality and efficiency. 

To build up the physique of children is a far more 
fundamental way of securing their health than to treat 
defects which should never have been allowed to de- 
velop. It is no less fundamental a way of securing their 
successful progress in school, as has been repeatedly 
shown by scientific tests taken among school children. 
Dr. W. T. Porter of the Harvard Medical School in 
1893 first showed in a study of 30,000 children that the 
majority of those who were physically advanced beyond 
the average showed proportionate mental advance, and 
correspondingly, the majority of children who were phys- 
ically retarded, gave evidence of mental retardation. To 
illustrate, he found that among pupils of the same age, 
ranging from 6 to 18 years, the average height and 
weight of those who were in the higher grades were 
greater than of those who were in the lower grades. 

With the increasing light that is being thrown from 



144 HEALTH AND THE SCHOOL 

many sides on the whole subject of physical education, it 
is no longer possible to dismiss its claims with a few 
perfunctory calisthenics rung in at recess or between 
classes. While we cannot to-night go into a detailed 
study of the modern conception of physical education, I 
can call your attention to at least two underlying prin- 
ciples which will convince you of the importance of hav- 
ing this work under the control of experts, who can make 
it a dominant factor in a school system. 

1. The most pozverful impressions which children re- 
ceive are connected with their physical activity. — This 
suggests the great educational value of active games 
which not only give heart, lungs, muscles, and nerves 
their needful exercise, but present rich opportunities for 
mental and moral training. Physical education should 
be regarded as anything but an arbitrary system of 
muscle hardening and lung stretching. It is a process 
which makes use of children's fundamental instinct for 
active play to cultivate in them both mental and bodily 
vigor ; both moral and nervous poise. The physical edu- 
cation program should be in complete harmony with the 
entire school program, providing whatever necessary ex- 
ercise is not supplied through other school work; and 
through such exercise adding further instruction and 
life to the other school interests. This is often done 
successfully by employing historic dances, folk dances, 
and pantomimes to lend interest to the various festivals 
through the year — harvest home, Christmas, May Day, 
historic anniversaries, etc. 

We see that the successful physical director must be 
an educational expert. He must be no less a medical 
expert, for the educational aspect of physical training 
is no more important than its physiological bearing. 

2. Physical training must he hygienically adapted, not 



HEALTH SUPERVISION 145 

only to the age and sex of children, but to their individ- 
ual needs and limitations. — No one disputes this self- 
evident proposition, but how often does one see it in 
practice? How often are children with weak hearts 
under observation and suitable restriction in the school 
playground or gymnasium? How often are girls 
guarded from exposure or strain during days of special 
susceptibility? Such necessary personal supervision can 
indeed be carried out successfully only when the re- 
sponsibility for physical education is in capable hands, 
and the needs and limitations of individual children 
are carefully determined by a thorough system of physi- 
cal examination and inspection. 

This concludes the outline of the five specific needs 
for which our system of health supervision should pro- 
vide. Compared with what most other cities are as yet 
undertaking, our program appears highly ambitious; 
viewed from the standpoint of our actual needs, it evi- 
dently contains not one vmnecessary item. 

Mr. Ross. — I must confess that Miss Parsons' words 
have carried conviction, but there is one difficulty that 
I see looming large in the way of her program. It 
will cost too much ; it can never be carried out. 

Mr. Young. — You forget that the public is with us. 
It is the people who pay the bills. With public senti- 
ment in our favor, our success waits almost wholly 
upon the degree to which we apply the principles of 
scientific management to our health supervision. Few 
cities yet suspect the enormous increase in efficiency 
which the installation of scientific management would 
mean to their systems. High expense and low efficiency 
are the rule to-day. We intend to reverse this order. 
With this end in view we shall devote our next meet- 



146 HEALTH AND THE SCHOOL 

ing to a discussion of the principles of scientific man- 
agement as applied to health supervision in schools. 



Suggested Reading 

American School Hygiene Association. Proceedings 

OF the Fifth Congress. What Our Cities Are 

Doing for the Health of Our Children. 

Proceedings of the Sixth Congress. Problems of 

School Hygiene in Massachusetts. 
Denison. Helping School Children, Chapters VH, 

IX. 
GuLiCK AND Ayres. Medical Inspection of Schools. 
HoAG. The Health Index of Children. 
Hogarth. Medical Inspection of Schools. 
Kelnyack. Medical Examination of Schools and 

Scholars. 
National Society for the Study of Education. 

Ninth Year Book, Part L Health and Education. 



IX 



SCIENTIFIC MANAGEMENT IN HEALTH 
SUPERVISION 

Mr. Young. — When two people or more unite to se- 
cure a common end they are instantly confronted by the 
following questions: What steps must we take to gain 
our end? How can we best take these steps? Which 
of us can best take this step and which of us that? 

It matters not what the enterprise may be, whether it 
be to establish or conduct a church, a factory or a school 
system, these fundamental questions must be answered 
in some fashion before anything can happen. In other 
words, there must be agreement on some plan, some 
method of administration, and some form of organiza- 
tion. 

The degree of success which an enterprise reaches, 
provided the human element is constant, is in proportion 
to the adequacy of its program, its organization, and 
its administrative procedure. The organization and ad- 
ministration of an enterprise constitute its management. 
To bring these two factors to their highest possible effi- 
ciency is the aim of scientific management. It is this 
form of management which we propose to install in our 
system of health supervision. 

Our committee, after making a wide study of the 
kinds of management now current in health supervision 
systems, has certain plans and methods to propose, which 

147 



148 HEALTH AND THE SCHOOL 

are based upon a scientific analysis of the organization, 
methods, and results they have observed. Miss Parsons 
will present the report. 

Miss Parsons. — Scientific management has lately be- 
come a phrase to conjure with, but it stands for no sys- 
tem of magic. It stands rather for the application to 
any kind of human employment of two simple common- 
sense principles, which any normal mind can grasp at 
the first hearing. 

Mrs. Ross. — Then why has the world waited so long 
for business management to become a scientific art? 

Miss Parsons. — Because rule of thumb is hard to dis- 
place by scientific law. It has been no easy matter to 
abstract the principles underlying scientific management 
from the mass of details involved in practicing them. 
You remember Lamb's account of the origin of roast 
pig. It has taken the race a long time to discover the 
most economical and efficient way of roasting its pig. 
The recipe is a twentieth century discovery, fraught 
with tremendous importance, for it means that in time 
the pork barrel will hold enough for us all. 

Let us now examine the two underlying canons of 
the "gospel of efficiency," as Mr. Taylor, the chief apostle 
of scientific management, calls the system, and let us 
see how they can apply to our system of health super- 
vision. The first has to do with organization ; that is, 
with the distribution of duties, or "functions," as they 
are called in technical parlance. 

I. Duties must be so apportioned as to make each in- 
dividual in the whole body count for his maximum. — 
Such an apportionment obviously requires that each per- 
son be allowed to do only such work as he is best fitted 
to do. This means that he must be relieved of those 
duties which can be performed as well by some one 



SCIENTIFIC MANAGEMENT 149 

whose time is less valuable, and that he be prohibited 
from performing duties which can be better done by 
some one else. 

In a system of health supervision the application of 
this principle would affect the functions of the school 
physician as follows : He would be required to use his 
energies in finding means to promote the health of the 
children and in diagnosing and treating such diseases 
and defects as might develop in spite of his preventive 
efforts ; he would be relieved from making inspections, 
first examinations and clerical records, as nurses and 
clerks, whose time is less valuable than his, can perform 
such work under his instruction, as well as he ; finally, he 
would be prohibited from determining his own methods 
of diagnosis and treatment, as such decisions are best 
made by medical specialists. 

Dr. Latta. — Miss Parsons has proposed some very 
daring innovations. She can't match them all in a single 
city in the United States to-day, but in time every one 
of the cities will come around to them, for the scheme 
is fundamentally sound. 

Mr. Ross.— But 

Miss Parsons. — Pardon me just a moment, till we set 
before ourselves the second principle, the one which has 
to do with methods of administration. 

2. Duties and tasks must be so regulated that each 
effort shall secure a maximum result; to this end every 
process and material used must conform to standard. 

Mrs. Ross. — What is meant by "standard"? 

Miss Parsons. — The term "standard" is applied to the 
most scientifically determined methods or specifications 
which have been reached at the time the standard is 
drawn. A standard represents neither perfection nor 
finality, but it does represent the best that has yet been 



I50 HEALTH AND THE SCHOOL 

devised, and should therefore be strictly enforced until 
expert scientific study justifies changing it. 

Mrs. Ross. — Do these two principles which you have 
stated actually stake out the whole field of scientific 
management? If so, it seems to me that it is merely a 
wonderful system of mechanics with the human element 
practically eliminated. You fit your man to his groove, 
gear him up to the highest speed, and then press the but- 
ton. I should fear that our health supervision system 
would turn out to be merely an automatic mechanism. 
We want the nurses and doctors to remain human, to be 
interested in the children themselves. Isn't there danger 
that their judgments will be paralyzed by too much over- 
head regulation? 

Miss Parsons. — There is no danger of this. It is 
true that the principles, in the simple form stated, sound 
harsh and mechanical. That is merely because they had 
to be put abstractly. As a matter of fact, the human 
element, i. e., the interest, enthusiasm, cooperation, and 
prosperity of each man in the system is the very highest 
concern in scientific management. 

Mr. Martin. — I thought the highest concern was in- 
creased profits. 

Miss Parsons. — Increased profits of one kind or an- 
other — wealth, leisure, human comfort, health or happi- 
ness — are undoubtedly the greatest motives for develop- 
ing scientific management, but the chief concern in 
achieving this end must be to develop first-class men 
and women among the workers. This is one of the 
duties, the most fundamental of all, which was referred 
to in the bare statement that every process and material 
used in discharging a duty should conform to a standard. 

To arouse the best efforts of workers, to enlist their 
interest and initiative, is a critical task, which can sue- 



SCIENTIFIC MANAGEMENT 151 

ceed fully only when based upon the results of an accu- 
rate study of the motives which influence men and 
women ; in other words, upon psychologically sound 
standards. Not all supervisors can be expert psycholo- 
gists, but they can increase their efficiency greatly by 
adopting standards set by experts in human nature. 



MEDICAL INSPECTION IN SCHOOLS 

Let us consider now in some detail the bearing that 
these principles of scientific management have upon our 
proposed system of health supervision. I shall not at- 
tempt to outline a complete set of regulations for organi- 
zation and procedure. We could not possibly cover so 
much ground in one evening, but I wish to bring out 
certain points where the application of these principles 
will give our system an advantage over any single sys- 
tem that we have yet observed. We will first take up 
the medical department, which at our last meeting we 
agreed should be responsible for inspection, examination, 
and treatment of school children. 

Medical inspection is almost everywhere carried on at 
enormous waste of the physician's time and the public's 
money. This is due, in part, to unscientific organiza- 
tion ; in part, to unscientific method. 



ORGANIZATION OF MEDICAL INSPECTION 

Let us consider first the organization. When doctors 
are assigned to make inspections and first examinations 
of school children, as is usually the case where these 
steps are taken, they are often required to perform a 



152 HEALTH AND THE SCHOOL 

great deal of work that can be done as well by nurses 
and even teachers and clerks. Such an arrangement 
violates the first canon of scientific management, which 
prohibits an individual from doing work that can be done 
as well by some one else whose time is less valuable. 

Mrs. Ross. — Do you mean that much of the work of 
inspection and examination can be carried on without 
doctors ? 

Miss Parsons. — Exactly. 

Mrs. Ross. — Then what becomes of the doctor's divine 
right of diagnosis? 

Miss Parsons. — That remains quite intact. The doc- 
tor is still needed to pronounce the authoritative word 
upon conditions of the body, but he can be immensely re- 
lieved in the routine of physical examination and 
inspection work by trained assistants who do not 
happen to possess the mystical power inherent in the 
symbol M. D. Let me illustrate by citing a very inter- 
esting experiment which has just been carried out in 
New York. 

In 191 1 the Bureau of Municipal Research made a 
test which brought out the fact that the cost in New 
York of physicians' inspection for contagious diseases 
was 58.1 cents per 1,000 children per day, while the cost 
of nurses' inspection was 36.96 cents, a difference of 
22.14 cents, or 38 per cent. Think what the saving to 
New York would be if its 750,000 children were to be in- 
spected for 22.14 cents less per thousand per day than 
under physicians' inspection. This amount, which would 
be about $33,000, would provide for a year all necessary 
treatment for the chronic defects of about 60,000 chil- 
dren; 45,000 of whom would require attention for their 
teeth, 30,000 for verminous conditions, 12,000 for defec- 
tive vision, 6,000 for mouth breathing, deafness, and dis- 



SCIENTIFIC MANAGEMENT 153 

charging ears, and 3,000 for diseased scalps, chronic 
eczema, and ringworm.* 

Mrs. Ross. — Might not the children be getting all this 
treatment at the expense of those inspected by the 
nurses? Economy is good, of course, but efficiency is 
better. Did the nurses really perform the inspection 
work as well as doctors would have done it? 

Miss Parsons. — Precisely as well. In the four schools 
where the nurses handled all the work of inspection and 
exclusion, not one of the forty-one exclusions which 
they made was found to have been unnecessary, nor was 
there one case found of a child passed over who should 
have been excluded. The Bureau of Municipal Re- 
search, which carried on this experiment, recommended 
that the inspection and exclusion of contagious diseases 
for the entire city be given to the nurses. 

Mrs. Ross. — Was this done? 

Miss Parsons. — It was in 1912, and the results have 
already shown the wisdom of the arrangement to be past 
argument. Though the force of school physicians was 
reduced between one-half and one-third, and the num- 
ber of nurses not proportionatey increased, there has 
been a marked increase in the number of physical exam- 
inations, inspections, and corrections of physical defects 
of the school children. Owing to time saved from in- 
spection work the school physicians have averaged an 
increase of about 100 per cent, in the number of physical 
examinations they have made. As a result of the greater 
number of nurses employed, the number of inspections 
has been 25 per cent, larger than in the previous year, and 
the number of cases receiving treatment about 10 per 
cent, greater. Furthermore, this added efficiency has been 

* Based upon a study of cost of school clinics in Medical In- 
spection of Schools, by A. Hogarth, Chapter XV. 



154 HEALTH AND THE SCHOOL 

brought about at an outlay of $4,800 less than the outlay 
of the previous year under the old regime.* 

Mrs. Ross. — Has the new plan in New York proved 
popular among those engaged in the work? 

Miss Parsons. — Not altogether. Some of the doctors 
feel abused at the curtailment of their duties, and some 
of the nurses object to the burden of their new respon- 
sibilities. A little friction at the beginning is quite in- 
evitable when such a radical change is being put into 
force. Prejudices will gradually yield, however, for the 
nurses' capacity both to inspect and even to examine chil- 
dren to a certain point has been demonstrated over and 
over again, not only in experiments but in actual practice. 

In Cambridge, England, in 1906, the school nurse was 
given authority by the medical officer to exclude cases, 
issue return certificates, and even to treat certain minor 
afflictions on her own initiative. Her service has proved 
eminently satisfactory. Massachusetts, the only state up 
to 191 1 to require school physicians in every town and 
city, has also demonstrated the fitness of the school nurse 
both for the inspection of contagious diseases and the 
examination for defects. The smaller towns, after the 
mandatory legislation went into effect, had at first great 
difficulty in arranging for school physicians on account 
both of the expense and also of the professional jeal- 
ousy of the private practitioners, who naturally objected 
to having their own young patients pronounced upon by 
a rival physician and a political appointee at that. 

By a liberal construction of the law a nurse was ap- 
pointed in Canton, Mass., in 1908, to perform for the 
school children what would have been expected of a 
physician. She made inspections for contagious diseases, 

* A Report upon the Health Conditions in the Public Schools 
of New York City, The Medical Record^ August 31, 1912. 



SCIENTIFIC MANAGEMENT 155 

examined children for physical defects, sent sick and 
defective children to their family physicians for treat- 
ment, and saw that they received it. Those too poor to 
pay for treatment she took to a free dispensary in the 
nearest large town (Boston). In addition to these duties 
she carried on educational work in hygiene with both 
parents and teachers. This nurse proved so efficient as 
a school health officer and gave so much satisfaction to 
the whole town, including the doctors, that one small 
place after another in Massachusetts has followed the 
example of Canton, leaving the health supervision of the 
school children entirely to a nurse. Massachusetts has 
not been alone in this experiment. Among other states, 
California is demonstrating the ability of nurses who, 
in San Francisco and Oakland, conduct practically all 
the routine of examinations. 

Mr. Ross. — You spoke of school physicians at present 
being assigned to do teachers' and clerks' work as well 
as nurses' work. How does that come about? 

Miss Parsons. — Much of the routine of physical ex- 
amination, such as taking weights and measures and 
setting down records, can actually be performed by 
teachers and clerks and even pupils, saving not only the 
physicians' time but the nurses' as well. There is no 
justification for the costly combination of doctor and 
nurse now in vogue, by which the doctor plays nurse 
and the nurse plays clerk. 

Mr. Ross. — It seems to me your nurse-teacher-clerk 
combination must necessarily lessen the value of the 
examination. 

Miss Parsons. — Not at all. The clerks or the older 
pupils are as efficient as doctors or nurses for taking 
down records; the teachers as reliable as doctors for 
making preliminary eye and ear tests ; and the nurses 



156 HEALTH AND THE SCHOOL 

themselves, as we have seen, are as competent as ordinary 
physicians to detect other physical abnormalities which 
should be referred for expert medical advice. 

Dr. Latta. — No doubt many physicians would ques- 
tion Miss Parsons' last statement regarding" the diagnos- 
tic abilities of nurses. As a matter of fact neither a 
nurse nor an ordinary doctor is qualified to say that a 
child is really sound. The powers of an expert diagnos- 
tician are required to secure any sort of certainty in such 
a matter. Occasionally we find a most healthy appearing 
child who is really suffering from a fatal disease. The 
symptoms of kidney disease, for instance, are likely to 
escape any but expert methods of detection. Such cases 
are rare, however, and while over 50 per cent, of the 
nation's children even now are having no physical ex- 
amination whatever, are we not wasting time to discuss 
impracticable refinements of methods for eliminating all 
error in examination? 

What we want now is to find means of giving all our 
25,000,000 school children the advantage of at least 
some sound health supervision. To have expert physi- 
cians examine every member of this enormous army is 
manifestly impossible ; but nurses under physicians' direc- 
tion are likely to prove equal to the task. 

Mr. Ross. — May I ask whether a distribution of physi- 
cal examination work between teachers and nurses, such 
as Miss Parsons described, has been tried anywhere? 

Miss Parsons. — It has. Massachusetts, the leading 
state in providing for the physical welfare of children, 
leaves the preliminary eye and ear tests to teachers, with 
the thorough endorsement of the oculists themselves. 
There is really nothing, they say, in the training of an 
ordinary physician that makes him a better tester of 
vision and hearing than an intelligent teacher. Minne- 



SCIENTIFIC MANAGEMENT 157 

sota is even training her teachers to make general physi- 
cal examinations, the claim being that trained teachers 
can recognize 90 per cent, of the defects of children, 

Mrs. Ross. — I was interested to learn, not long ago, 
that Swarthmore College, recognizing the direct responsi- 
bility of teachers toward the health of children has ac- 
tually added a course of medical inspection to its teach- 
ers' preparatory course. School children are brought to 
the college every week and the students under the super- 
vision of the physical director are taught the methods of 
inspection and examination. 

Mr. Martin. — This is all very bewildering to me. It 
seems to me that such innovations will tend to unseat the 
doctors entirely. 

Dr. Latta. — Oh, not at all. The effect will only be to 
seat them higher up. The whole purpose of this sharply 
economical distribution of duties is, as you remember, to 
make each individual count for his maximum. The or- 
dinary physician, as now trained, is working at his maxi- 
mum when he is diagnosing and treating disease, not 
when he is sorting out healthy from unhealthy children. 
We must save him for his function as a healer, a neces- 
sity which was thoroughly discussed at our last meeting. 

Mrs. Ross. — I am rather surprised to hear you empha- 
size so strongly the healing function of the school doctor. 
I thought the modern doctor was to keep children well 
and develop their health. 

Dr. Latta. — So he is ; but, while our schools still con- 
tain between 60 and 80 per cent, of defective children, 
there is much old-fashioned treating to be done, and 
the old-fashioned school doctors can't employ their time 
better than by doing it. In the meantime, not a moment 
should be lost, of course, in developing a new breed of 
doctors and nurses who shall be hygienists first of all, 
12 



158 HEALTH AND THE SCHOOL 

rather than healers. Children under their care, from 
birth and before, will not develop the hideous array of 
defects and diseases now prevalent among all the chil- 
dren of the nation, regardless of wealth or station. 

To return to the question of substituting nurses for 
doctors in inspection work : I regret to admit that some 
of the motives which prompt resistance to this plan are 
not entirely concerned with the welfare of the children. 
It is a disconcerting thing, for instance, to a politically 
inclined medical chief to see $75,000, more or less, about 
to be diverted from the support of a body of male medi- 
cal inspectors who on occasion can serve as a forceful 
political instrument. It is also disconcerting to the in- 
spectors to contemplate losing their jobs. I am far from 
implying that all doctors who oppose the inroad of the 
school nurse do so with any sordid motive. Many of 
them are honestly imbued with faith in their own mystic 
powers. I merely say that the economic motive strength- 
ens the conservative element in the medical profession 
which has always resisted innovations, tooth and nail, 
since before the day when Hippocrates horrified society 
and called down the anathemas of his fellow doctors 
by announcing that fits developed from natural causes 
and were not malign gifts from the gods. Magic and 
common sense have waged immemorial combat in medi- 
cine, but we trust that common sense, with her powerful 
handmaid — modern science — will, from now on, hold the 
upper hand. 

Miss Parsons. — Let me call your attention now to 
the second weak spot in the organization of most in- 
spection systems. The change involved, contrary to the 
one just discussed, will require a greater outlay, but 
will also -increase the efficiency of the service. I refer 
to the common practice of leaving to untrained teachers 



SCIENTIFIC MANAGEMENT 159 

the actual detection of contagious diseases. This is in 
direct violation of the principle we stated ; that individuals 
should be prohibited from performing duties which can 
be better done by some one else. 

"What is called physicians' inspection is primarily teach- 
ers' inspection, the physician inspecting only such cases 
as the teachers select. The result is that many a case 
requiring expert advice misses the untrained teacher's 
eye, and never passes under the physician's. On the 
other hand, much of the physician's time is wasted in 
sifting out cases unnecessarily sent by teachers. A 
physician's class-room inspection made in 1910 among 
1,784 school children of Philadelphia showed that about 
12 per cent, of those needing treatment for minor con- 
tagious diseases had failed to be observed by the teach- 
ers. On the other hand, in a single month of the same 
year, one inspector had 569 pupils sent to him by teach- 
ers, only 14 of whom (2.4 per cent), in his judgment, 
were proper cases for his attention. Medical inspection 
is surely a curious misnomer for teachers' inspection of 
this sort. 

Mr. Ross. — What better plan is there? 

Miss Parsons. — The children should have periodic in- 
spection by people who know how to give it. Teachers, 
unless specially trained for it, do not know how. Nurses 
do. New York and a number of other cities are now 
requiring a direct monthly inspection of all children by 
nurses. The results have already far more than justified 
the wisdom of the arrangement. 

In this brief discussion of the organization of medical 
service we shall not need to take up the duties of super- 
visors. Most systems are already well supplied with 
these functionaries. Their methods rather than their 
functions call for scrutiny, and these are of so much 



i6o HEALTH AND THE SCHOOL 

importance that we shall have to give a separate evening 
to their consideration. 



METHODS OF MEDICAL INSPECTION 

In considering methods, we must hold carefully before 
us the principle that duties should be so regulated that 
each effort shall secure a maximum result, and that to 
this end every process and material used must conform 
to standard. 

It is at this point in current medical inspection that 
we encounter chaos. The conception of a standard as 
being the only means for securing both the greatest effi- 
ciency and economy has exerted no influence on most of 
our systems. We find almost nowhere scientifically 
fixed regulations concerning many of the following items : 
kinds of communicable diseases and symptoms for which 
inspection is necessary; kinds of defects and symptoms 
for which examination is necessary; manner and fre- 
quency of inspections and examinations ; character of 
treatment required ; time, place, and manner of giving it ; 
length of quarantine for various diseases; following up 
of excluded cases to insure proper treatment and quar- 
antine; further precautionary measures against conta- 
gion ; disinfection, exclusion, and treatment of exposed 
children; making, filing, and using records and reports. 

After a discouraging search for a scientifically man- 
aged system of medical inspection we at last came upon 
one which had recently been organized by management 
experts in one of our larger cities. This particular city 
had suddenly waked up to the fact that its medical in- 
spection service, on which it had long prided itself, was 
not making good; and it had promptly called in experts 



SCIENTIFIC MANAGEMENT i6i 

to set the system on its feet. Like many another city, 
this one had assumed that its medical inspectors were 
carrying out the following important steps : 

1. Inspection for contagious disease. 

2. Quarantine for contagious disease. 

3. Treatment of minor contagious disease. 

4. Yearly physical examination of school children. 

5. Referring of cases demanding treatment to proper 

authorities. 

6. Following up of cases referred. 

7. Consideration of special cases. 

8. Making of prompt and accurate reports. 

9. Directing and coordinating efforts under central 

supervision according to information from records 
and reports. 

Bearing in mind these points, you will be interested to 
note, item by item, the contrast between what medical 
inspection in the city under discussion was assumed to 
be and what it really was. This is v/hat the investigators 
found : 

I. Inspection for Contagious Disease. 

(a) Inspection work was carried on with enormous 
waste of time. During the year, routine visits to all 
schools every day had occupied 60 per cent, of the 
medical inspectors' time, with no greater result than the 
finding of 25 cases of major contagious disease among 
174,000 children. Major contagious diseases are seldom 
found in schools, for the obvious reason that their sever- 
ity from the first onset usually keeps children at home. 

Mrs. Ross. — Isn't this large expenditure worth while 
to discover even a few cases? The 25 cases which Miss 
Parsons cited might have multiplied to 2,500 cases if the 
doctors hadn't caught them in time. 

Miss Parsons. — To be sure; but it needn't have re- 



i62 HEALTH AND THE SCHOOL 

quired 28 doctors working for a year to do it. We have 
already seen that nurses could have done the inspection 
work ; but quite apart from that consideration, the doc- 
tors were wasting quantities of time by their methods 
of inspection. They were constantly paying hundreds 
of visits to schools where there was nothing for them 
to do. This waste of their time made the cost of the 
discoveries that they did make many times as great as 
necessary. 

Mr. Ross. — How could this cost have been reduced? 

Miss Parsons. — By so simple a method as the use of 
the telephone. Since the physicians, in all cases, in- 
spected only those children whom the teachers picked 
out, they would have saved an immense amount of time 
by confining their visits to those schools where the> 
were needed to pronounce on suspicious cases. Tele- 
phone calls could have brought them at any time. This 
point introduces us to the next defect which the experts 
noted in the system. 

(b) The system did not provide for periodic inspec- 
tion of all school children. Only those children who 
were selected by teachers, as occasion arose, were seen 
by the inspector. 

2. Quarantine for Contagious Disease. 

(a) Pupils were often allowed to return to school 
before the expiration of the exclusion term specified in 
the state law. 

(b) There was wide variation among inspectors, as 
to exclusion for similar diseases, with the result that 
there was much friction between the department of con- 
tagious diseases, on the one hand, and principals and 
teachers on the other. For instance, in the handling of 
suspected diphtheria cases, some inspectors excluded pu- 
pils immediately upon beginning the test of cultures from 



SCIENTIFIC MANAGEMENT 163 

the latter's throats; others waited until the presence of 
the disease was determined by the diphtheria baciUus de- 
veloped in the culture. In the handling of minor con- 
tagious diseases, exclusion authority was often abused. 
For example, of two inspectors working in similar 
schools having nurses, one was found rarely to exclude 
a child who could be treated by the nurse, the other ex- 
cluded almost all the children, thus depleting the school 
enrollment and preventing proper treatment by the nurse. 
Eighty-nine per cent, of the total number of exclusions 
were for causes other than acute diseases. Arbitrary 
wholesale exclusion for lack of evidence of recent vacci- 
nation was one of the contributing factors to this high 
percentage. 

3. Treatment of Minor Contagious Disease. — There 
was no uniform practice in school or home treatment for 
minor contagious diseases. 

4. Yearly Physical Examination of School Children. 

(a) Instead of each child's receiving an examination 
every year, as was called for, an investigation among 
5,910 children in attendance during five years showed 
that 9 per cent, had never been examined, 36.1 per cent, 
had been examined only once, 39 per cent, twice, 15 per 
cent, three times, 9 per cent, four times, and none five 
times. 

(b) There were no definite standards as to what 
should be considered physical defects. Inspectors who 
were specialists in private practice were accordingly 
found to discover their "specialties" in undue proportions 
to the neglect of other defects. 

(c) There were no working schedules or uniform 
methods provided for the examination of pupils. Each 
inspector, therefore, chose his own method of making 
eye and ear tests, which, in many cases, were inaccurate. 



1 64 HEALTH AND THE SCHOOL 

(d) There was wide variation in the time given to 
single examinations. This varied from six seconds to 
six minutes. A careful test has demonstrated that an 
examination, exclusive of any clerical work, cannot be 
properly given in less than seven minutes. 

(e) Inaccuracy of examinations was shown by the re- 
examination of 200 children representing twelve inspec- 
tors. The inspector who was detailed by the chief of 
the division to make a reexamination found 145 defects 
undetected in the first examination, and 57 previously 
recorded that were unworthy of notice. 

5. Referring of Cases. — Cases were not systematically 
referred to nurses, parents, and doctors. Cards were 
often filled out with recommendations that were not 
specific and given to children only. 

6. Following Up of Cases. — Cases were not followed 
up, but lost sight of. There was no standard of what 
a treatment should be. Pupils with errors of refrac- 
tion were reported "treated" when supplied with an eye- 
wash ; those with adenoids, when they began to use a 
gargle ; those with defective teeth, when they were given 
tooth brushes. A questionnaire test showed that, out of 
1,013 pupils recommended for treatment for defective 
vision during five years, only 14.9 per cent, were pro- 
vided with glasses; of 615 having enlarged tonsils or 
adenoids only 11.2 per cent, had received adequate treat- 
ment. 

7. Special Cases. — Special cases referred by principals 
and teachers were incompletely reported, neither uni- 
formity nor system being used in the reports. 

8. Reports. 

(a) Great variation and laxity were shown in filling 
out and turning in reports of contagious diseases. It 
was a common practice for an inspector excessively zeal- 



SCIENTIFIC MANAGEMENT 165 

ous to show a very large number of exclusions, to report 
the same pupil excluded for the same cause several times 
during one period of exclusion. 

(b) Reports of examinations, reexaminations, and re- 
sults of recommendations for treatment were not made 
promptly to the chief medical inspector. Their ijiac- 
curacy, moreover, made them practically useless. An in- 
vestigation of 200 children, representing 227 physical 
defects reported by thirteen inspectors as treated, showed 
that only 43 per cent, of the defects were treated in any 
proper sense. 

9. Administrative Control and Information. 

(a) There was no central control and supervision of 
exclusions and readmissions of pupils. 

(b) There was no adequate administrative control of 
the inspection system as a whole which was indicated 
by the fact that the inspectors were found to be averag- 
ing in the time given to their work less than one-half 
of the five hours a day they were expected to give. 

(c) No accurate information could be obtained for 
the entire city as to school days lost through exclusion, 
because the case records at the central office were either 
incomplete, inaccurate, or altogether lacking, and be- 
cause no provision was made in the records at the 
schools for currently recording the causes of absence. 

(d) The records in the central office were not kept 
up ; cards were missing or left unfiled for more than six 
months at a time. In April, 1909, there were 3,063 re- 
port cards relating to the school year 1908, still tied up 
in the bundles in which they had been received. 

I have thought it worth while to run over the short- 
comings of this system in some detail because similar 
ones are bound to crop out in every town that doesn't 
specially guard against them. Even a small town, like 



i66 HEALTH AND THE SCHOOL 

our own, which presents no great administrative prob- 
lems, needs precisely as good a plan and as clear-cut 
methods of management as the largest city. Good inten- 
tions and fine ideas about the health of children do not 
automatically result in healthy children. 

Mr. Ross. — Those people didn't know how to do busi- 
ness. I could have run their system better myself, and 
I don't know an adenoid from a potato. 

Miss Parsons. — It was just such administrative 
knowledge and experience as you have, Mr. Ross, that 
they needed and fortunately obtained. Let us now go 
over the items as they stood after the experts put the 
system on its feet. 

1. Inspection (a) and (b). — Much time formerly 
wasted is saved by substituting for a daily visit by the 
inspector to each school a weekly visit to each school 
room. The teacher is thus no longer responsible for 
detecting contagious diseases, nor are any children left 
uninspected. Any day, however, that the teacher notices 
suspicious symptoms, she can secure an inspection by 
telephoning to the school inspector at a specified time. 
The weekly schedule is subject to change in case of un- 
usual stress, as in epidemics. (Form 4, page 184.) 

2. Quarantine for Contagious Diseases. 

(a) The legal length of quarantine is now observed, 
as prompt records, carefully supervised, check laxity and 
irregularity in this matter. 

(b) Conditions warranting exclusion are accurately 
stated in the regulations and an inspector is now not 
permitted to exclude a pupil for a minor contagious dis- 
ease more than one day without the permission of his 
immediate superior. Exclusion for vaccination is also 
obviated by requiring the inspector to gain satisfactory 
evidence before pupils are enrolled. 



SCIENTIFIC MANAGEMENT 167 

3. Treatment for Minor Contagious Diseases. — Minor 
contagious diseases are now treated at school whenever 
possible. 

4. Yearly Examinations. 

(a) Every child is now examined when he enters 
school, and regularly every year thereafter. If need 
arises in special cases for an earlier examination, this is 
given. This regulation is enforced by a system of 
prompt reports and close supervision. 

(b) and (c) Examinations and inspections are made 
according to a prescribed schedule, which definitely de- 
termines what defects to look for, how to look for them, 
when and how to treat them, and how to record the re- 
sults of examination. (Form i, page 179.) 

(d) and (e) To secure the greatest possible uni- 
formity in standards and methods, stafT conferences and 
clinics are held at regular intervals. 

5. Referring of Cases. — Carbon copies of records are 
now sent promptly to all parties interested — central of- 
fice, teacher, and nurse ; the inspector retaining a copy. 
The nurse is responsible for informing parents and see- 
ing that the treatment recommended is carried out ; the 
teacher for giving what special consideration the case 
may require ; the inspector for bringing the case to a 
conclusion, and the central office for exercising a general 
supervision until the completed record is received. 
(Form I, page 179.) 

6. Folloziing Up of Cases. — Cases are now easily fol- 
lowed up, as a record is in the hands of the four parties 
interested. A definite standard for the necessary treat- 
ment, and the result necessary to warrant the discharge 
of the case, makes the procedure for each case clear. 

7. Special Cases. — Thorough examinations of special 
cases referred by principals and teachers are now given 



i68 HEALTH AND THE SCHOOL 

at the weekly visits of the inspectors, and are reported at 
once, as in the case of regular examinations. 

8. Reports. 

(a) Accurate card reports of inspections are promptly 
sent to the central office, where they are kept on file. 

(&) Accurate reports of reexaminations and results 
of treatment are made on the card that recorded the 
orginal examination, and as soon as the cases are dis- 
missed are sent to the central office, where they are 
filed. 

9. Administrative Control and Information. 

(a) and (b) The central administrative control has 
been greatly strengthened by the establishment of stand- 
ards of procedure ; a system of simple records, including 
time reports (Form 2, page 181), which are turned in 
promptly and used ; and a program of stated staff con- 
ferences and clinics for securing the greatest possible 
uniformity in standards and methods. 

(c) and (d) Complete records, intelligible to the pub- 
lic, of the physical condition of the school children, as 
well as of the results obtained through recommended 
treatments, are now available in the central office. These 
records include a monthly summary of all cases handled 
during the month (Form 3, page 183) ; new cases, those 
still pending, and those dismissed as cured. This sum- 
mary is published in health news columns of the news- 
papers every month, together with statements regarding 
the cost of handling the various items. 

Mr. Young. — Those people are certainly getting their 
money's worth now, but will they continue to? How 
long will it be before the varnish wears off their sys- 
tem? It sounds too good to last. 

Miss Parsons. — If it doesn't last it will be due to 
the grossest neglect of city officials and citizens. In 



SCIENTIFIC MANAGEMENT 169 

ordinarily honest and efficient hands this system will 
stand wear. 

Mr. Ross. — I believe you are right, Miss Parsons. 
When we installed scientific management in our factory 
we didn't change a single important manager or fore- 
man, but the new system doubled our profits in a year. 

Miss Parsons. — Double profits in health are what we 
are figuring on in this medical inspection system. Let 
us turn now to what scientific management has to say in 
the department of sanitary supervision. 



SANITARY inspection OF SCHOOLS: ORGANIZATION AND 
METHODS 

Sanitary inspection is usually carried on in connec- 
tion with medical inspection, owing to a curious tra- 
dition that it takes a doctor to determine whether 
enough air is entering a room, whether children are us- 
ing sanitary drinking cups or the thermometer stands too 
high. These items have not the remotest connection with 
surgery, obstetrics, materia medica, or with any of the 
other arts which go to make up the doctor's distinctive 
repertoire. The smattering of sanitary knowledge that is 
offered in an ordinary medical course, and which con- 
stitutes the physician's only claim as a sanitary authority, 
is distinctly less than what is included in a good course 
in domestic science. 

However, it is often convenient for the medical in- 
spector, physician or nurse, to examine children and 
buildings at the same time, and there is no harm in 
this arrangement if the sanitary standards are not left 
to the determination of these inspecting officers. Modern 
sanitation has developed into a fine art. Experts only 



I70 HEALTH AND THE SCHOOL 

are qualified to set standards, and the inspecting officers 
for schools or homes, whoever they may be — doctors, 
nurses, or policemen — must make their reports on the 
basis of standards set or ratified by expert sanitarians. 
Moreover, the form for inspection records must be so 
devised as to provide for a thorough and accurate report 
on every item. It is an evidence of the extreme youth of 
the inspection systems in this country that most of them 
have not yet discovered these two simple and self-evident 
requirements. 

Prevailing methods of sanitary inspection are well 
illustrated in the report on the city system we have been 
considering. The duties of the sanitary inspectors in 
this city were as follows : 

1. The exact determination of the sanitary construc- 
tion and equipment of each school building, as a basis 
for a permanent record. 

2. Systematic and periodic inspections to guard 
against new conditions harmful to health. 

These duties, it was found, were being carried out in 
the following manner : 

1. Permanent Records of the Sanitary Construction 
and Equipment of School Buildings. — There were no 
such records. 

2. Periodic Inspections. 

(a) Periodic inspection, which was made at the open- 
ing of the year, was insufficient to tell the whole story of 
conditions that vary through the year : e. g., heating, 
ventilation, sanitation. 

(&) No sanitary standards were prescribed for use in 
reports, each inspector being allowed to establish his 
own standards. The making of reports was regarded 
as a mere form by inspectors, who based their state- 
ments concerning capacity of rooms, size of windows. 



SCIENTIFIC MANAGEMENT 171 

etc., on general estimates, and who frequently omitted 
salient items. For example, among all the reports, only 
five recommended better ventilation, while the depart- 
ment of buildings admitted that there were 162 buildings 
whose ventilating systems furnished less air than the 
law required. Similarly, only fourteen recommended in- 
creased toilet facilities, while the Board of Education 
admitted that there were at least forty-three schools 
deficient in this respect. 

(c) The reports were apparently recognized as worth- 
less by the Board of Education, which paid no attention 
to them. Out of 131 recommendations submitted in 
October, 1909, none had received any consideration up 
to April, 1910. 

(d) There was nowhere maintained a complete cur- 
rent record of information necessary for the improve- 
ment of the hygienic conditions in school buildings, nor 
was there a record showing improvements obtained 
through the service of inspectors. 

The following is a condensed statement of the changes 
brought about through the revision of the system. 

1. Permanent records of the sanitary construction and 
equipment of school buildings have been made and filed 
at the central office. 

2. Periodic Inspection. 

(a) Inspection is now made three times a year, in 
order to note conditions subject to variation : for exam- 
ple, heating and ventilation. 

(b) A definite schedule is used to record the inspec- 
tions which are now governed by facts instead of indi- 
vidual judgments. (Form 5, pages 187-8.) 

(c) and (d) The information in these reports is con- 
sidered in connection with the permanent records relat- 
ing to th^ respective buildings, transferred to these rec- 



172 HEALTH AND THE SCHOOL 

ords and filed. Records showing improvement obtained 
as results of reports are filed with reports. 

It will not be necessary to go into further detail to- 
night to illustrate the need for scientific regulations in 
every department of our health supervision system. The 
same general method of administration as we have out- 
lined in the two departments discussed is obviously neces- 
sary for securing real success in the other branches of 
the service : hygienic regulation of school and home 
activities, health instruction and physical education. 

Mr. Martin. — The changes that transformed these 
poor systems into effective ones all sounded very simple 
and easy, though apparently it required experts to bring 
them about. As you were putting the contrasted items 
before us. Miss Parsons, I tried to analyze the essential 
elements that distinguished the systems before and after 
treatment. Would you mind stating what you consider 
the fundamental differences? 

Miss Parsons. — In a word, a system of management, 
'to be puncture-proof, must provide for each of these 
things : a good plan, accurate records, and thorough su- 
pervision. These provisions can be secured only through 
a rigid application of the principles of scientific manage- 
ment, i. e., proper distribution of duties, and observance 
of standards. The system we first considered this even- 
ing had a good general plan, but it broke down through 
having inaccurate, ill-kept records, and almost no super- 
vision. It is absolutely essential for the supervising of- 
ficer, by means of strict records, to keep in close touch 
with the work of every inspector ; to control the quantity 
and quality of service performed by each ; to apportion 
work in accordance with the requirements of districts, 
schools, or individual pupils ; and to tell the story of 
work done and needs still to be met in such a way as to 



SCIENTIFIC MANAGEMENT 173 

command the intelligent interest, confidence, and support 
of the community. 

Mr. Ross. — Miss Parsons makes an important point 
when she bespeaks the cooperation of the community. 
The citizens are the real proprietors of these proposed 
health factories. No plan, however perfect, can thrive 
without their support. 

As citizens and taxpayers, we must all insist on being 
currently and accurately informed of what our system 
is accomplishing; how much health it is manufacturing; 
what it costs ; what it saves ; how it can be yet further 
improved. We must aid in the formulation of construc- 
tive plans when there is need, and we cannot rest till 
plans for the health of our school children have been 
actually transmuted into health itself. 



Suggested Reading 

Allen and Snedden. School Reports and School Effi- 
ciency. 

Minnesota State Board of Health. An Outline for 
the Health Grading of the School Child. 

Russell Sage Foundation. TJie Measurement of Edu- 
cational Processes and Products. 

Taylor. The Gospel of Efficiency. American Magazine, 
March-May, 191 1. 
The Principles of Scientific Management. 

Terman. Professional Training for Child Hygiene. 
Popular Science Monthly, March, 1912. 



13 



X 

RED TAPE 

Mr. Young. — At our last meeting Miss Parsons 
sketched for us the transformation of a nerveless medical 
and sanitary inspection system into one that was highly 
efficient. Our limited time prevented us from getting 
more than a hint of the methods which brought about 
this transformation, but we did receive the definite im- 
pression that the secret of the change lay almost entirely 
in a reorganized system of records and supervision. 

Mr. Ross. — In other words, the work amounted to 
almost nothing until it was well watched and accurately 
recorded. 

Mr. Martin. — Does this mean that doctors and nurses 
are shirks or fakirs unless there is some one always at 
their heels? I can't believe that for a moment. 

Mrs. Ross. — Nor I. In spite of the evidence in last 
week's report, I can't quite abandon the idea that the 
best way to win good service is to put people on their 
honor and to measure their efficiency by the results they 
accomplish. Surely this is better than to carry on a 
system of espionage. 

Miss Parsons. — The question is not primarily a mat- 
ter of integrity and good intention, but of intelligent 
procedure and economy in the use of time. Effective 
supervision, on the other hand, does not mean a system 
of espionage; it means rather the intelligent direction 

174 



RED TAPE 175 

and coordination of the service ; the analysis, classifica- 
tion, and interpretation of results ; and the establishing 
of standard administrative methods. 

Mr. Martin. — Isn't there danger of over-standardiz- 
ing and over-mechanizing in the field of professional 
service? I can readily see the necessity of standardizing 
the speed of machines or a method of keeping ac- 
counts. When it comes to matters requiring expert medi- 
cal judgment, however, I should fear that laying down 
hard and fast standards would check individual initia- 
tive and would degrade professional service to the dead 
level of routine. 

Miss Parsons. — That could happen only if a standard 
were a thing impossible to change, but such is not the 
case. As was brought out in our last discussion, a 
standard is not to be regarded as something final and 
unchangeable, but merely as the most effective method 
or equipment that scientific inquiry has discovered up to 
date. In fixing upon a standard of procedure in the 
medical examination of school children there is nothing 
that precludes the modification of the standard, provided 
only the change be based upon the same rigid test that 
was applied when the standard was originally prescribed. 

Mr. Martin. — May we not have this point illustrated 
by a concrete example of standardization in some field 
of professional service? 

Dr. Latta. — An excellent example is in the practice 
of surgery, which, I suppose, would be accepted as the 
highest type of technical skill in handwork. In teach- 
ing the technique of an operation upon the eye, for in- 
stance, the instructor prescribes every step in the process, 
every movement, and every instrument to be used. Not 
until the student masters every detail of the operation 
may he undertake its execution. Having mastered the 



176 HEALTH AND THE SCHOOL 

best standard which surgical practice has already estab- 
lished, the student is free to use his initiative and in- 
genuity in raising the standard, but not before. No one 
would think of criticising surgical practice on the ground 
that it interfered with professional initiative or placed 
obstacles in the way of rational progress. 

Mr. Young. — I should be interested to have Miss Par- 
sons tell us just how far standardization should be car- 
ried in the supervision of medical examination and 
nurses' service. 

Miss Parsons. — The first requisite of efficient super- 
vision is that accurate, complete, and prompt informa- 
tion be available to the supervisor. In other words, the 
supervisor must know just what the inspectors are do- 
ing and what they are failing to do ; and he must get 
this knowledge in time to check up the results and cor- 
rect mistakes, instead of getting it in an annual report 
long after the time when he can make most effective use 
of it. For this purpose, it is absolutely essential that a 
system of current reports be installed that will produce 
the necessary information promptly and in a form readily 
available to the supervisor. 

Mr. Young. — Do not most systems of medical exami- 
nation include weekly or monthly reports that serve pre- 
cisely the purpose you have in mind? 

Miss Parsons. — Practically all of them provide some 
form of current report; but none of them, so far as I 
have discovered, meets adequately the requirements of 
scientific management. The fundamental basis of all 
summary reports, of course, is the primary record of 
individual facts observed. In medical examination these 
primary facts are contained in the record of conditions 
found in individual children. Very commonly the char- 
acter of this record is left almost wholly to the discre- 



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178 HEALTH AND THE SCHOOL 

tion of individual examiners. The inevitable result is 
great variation in the form, order, and definiteness of 
the records. It has repeatedly been found that, unless 
there is a prescribed schedule which medical inspectors 
are required to follow in their work, some of the most 
obvious physical defects will be slighted or entirely over- 
looked by certain inspectors. One inspector, for exam- 
ple, may have an exaggerated interest in children's ade- 
noids, and pass over defects of vision, as if he himself 
were blind. Another inspector, with special interest in 
visual defects, may find that most children need glasses, 
but fail utterly to note the presence of decaying teeth. 
We have prepared a chart which brings out this ten- 
dency to specialization among the inspectors in one of 
our largest cities. 

Mrs. Ross. — How can this mental astigmatism of med- 
ical inspectors be corrected ? Isn't it a natural and inev- 
itable result of differences in training and native in- 
terest ? 

Miss Parsons. — It is natural, but by no means in- 
evitable. By laying down precise standards of method 
and procedure to be observed in the routine of medical 
examination ; by instructing inspectors carefully concern- 
ing the importance and meaning of these standards ; and 
by the proper exercise of control on the part of super- 
visors, the eccentricities of medical inspectors can be 
almost entirely eliminated. For this purpose it is essen- 
tial that the blank forms upon which inspectors make 
their records of individual examinations and their sum- 
mary reports be so devised as to induce completeness, 
definiteness, and uniformity in the examination of chil- 
dren, in the necessary follow-up work, and in the reports 
of time distribution and results obtained. The four 
blank forms that we wish to submit as part of our report 



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i8o HEALTH AND THE SCHOOL 

have been devised to accomplish these purposes. I will 
ask Mr. Ross, who has helped us greatly in preparing 
these forms, kindly to explain them to us. 



RECORD OF INDIVIDUAL EXAMINATION 

Mr. Ross. — Form i is designed as a record of indi- 
vidual examinations. In the main the form explains it- 
self, but it may be well to summarize, very briefly, the 
advantages which it offers. 

1. It provides a working schedule and prescribes the 

order in which the observations of inspectors 
shall be made. 

2. It provides for economy in clerical labor through 

the use of check marks and of standard symbols 
in recording. 

3. It brings together on a single slip, four by six 

inches in size, the complete record of each series 
of observations on a given child. 

4. It makes possible, by the use of carbon sheets, the 

preparation of several copies of the record at a 
single writing, so that a duplicate of the inspec- 
tor's record can be furnished to the principal of 
the school and through him to the teacher, to 
the nurse, to the parent if desirable, and to the 
supervisor of medical inspection for purposes of 
control. 

The copy of the record which goes to the su- 
pervisor's office is filed under the date of the 
original examination and this becomes a charge 
against the inspector, to be removed only when 
the defects noted have been corrected, when the 
child dies, or moves from the city, or when the 



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i82 HEALTH AND THE SCHOOL 

case is otherwise closed by authority of the super- 
vising officer. 
5. It provides the medical inspector with a convenient 
means of preparing his daily and monthly reports. 
By separating into appropriate piles the slips rep- 
resenting the work of a given period an inspector 
can, in a few minutes, obtain the figures to be 
entered on the forms for summary reports. 

DAILY SERVICE RECORD OF MEDICAL INSPECTION 

Form 2 is designed as a daily record of the service 
performed by each medical inspector. It provides for 
a detailed account of the location of the inspector and 
the distribution of his time for every hour of his work- 
ing day. The record of examinations for physical de- 
fects, as entered upon this form, gives only the totals 
of new cases and of old (pending) cases examined. The 
details concerning medical examinations are provided for 
on Form 3, the totals of which for a given period must 
agree with the totals for the same period on Form 2. 
The record of examinations, exclusions, and readmis- 
sions of contagious disease cases is provided for in detail 
on Form 2; the daily totals for individual schools being 
entered upon Form 3. 

MONTHLY BALANCE SHEET 

Form 5 is designed as a monthly record of each in- 
spector's service in individual schools ; a separate report 
being rendered for each school. On this form is en- 
tered, day by day, a summary of the contagious disease 
cases excluded, readmitted, and dropped. The number 
of cases readmitted and dropped, subtracted from the 
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HEALTH AND THE SCHOOL 



given date. Provision is made for an exact accounting 
for all pupils found to have defects. The number of 
such pupils, decreased by the number regularly dis- 
charged, gives the number of cases pending at any 
time. This number must agree with the number of 
slips (Form i) on file in the supervisor's office; so that 
an exact balance must be maintained at all times. 

A similar account is provided for the various kinds 
of defects discovered and corrected, so that the number 
of defects, as well as the number of defective children, 
charged to each medical inspector constantly appears on 
the record as an index of the efficiency with which in- 
spectors and nurses are following up their cases and 
securing the cooperation of pupils, parents, teachers, and 
family physicians. 



Department of Public Health and Charities — 
Philadelphia 

BUEEAU OP HEALTH DIVISION OF SCHOOL MEDICAL INSPECTION 

RECORD OF CLASSROOM INSPECTIONS 

GRADE CLASSROOM 

SCHOOL MEDICAL INSPECTOR 






NAME OF PUPIL 


DISEASE 

OB 
DEFECT 


DATE 
DISCOVERED 


DATE OF INSPECTION AND ACTION TAKEN 1 



































FORM 4. — MEMORANDUM OF CLASS ROOM INSPECTIONS. 



RED TAPE 185 



MEMORANDUM RECORD OF CLASS-ROOM INSPECTIONS 

Form 4. This record contemplates a periodic inspec- 
tion (weekly or bi-weekly), in the class-room, of every 
pupil by a medical inspector or nurse. The object of 
this inspection is the prompt detection of contagious dis- 
eases and the discovery of pupils in need of special ex- 
amination for physical defects. One of these cards for 
each class-room is maintained by the inspector who, at 
each successive visit, enters a record of new cases dis- 
covered and the status of each of the pending cases until 
the case is finally disposed of. A summary of these class- 
room inspections is entered in the inspector's daily report 
(Form 2), and this finds its way into the monthly and 
annual statement of service rendered and results accom- 
plished. 

Mr. Martin. — Isn't there a good deal more red 
tape about this system of records than is neces- 
sary; and will not the results be that medical inspec- 
tors will spend valuable time in compiling records 
that will never be used, rather than in discovering 
physical defects of children and in getting them cor- 
rected ? 

Mr. Ross. — The clerical work involved in the prepa- 
ration of the summary reports will not require more than 
twenty minutes a day of each inspector, so that the 
amount of "red tape" will not be a serious burden. Even 
if much more time were required, however, it would be 
well spent if it enabled supervisors and inspectors to 
have constantly before them a clearly defined picture of 
service and results. 

Miss Parsons. — If it were silver coins, rather than 
live children, that were being entrusted to the care of 



i86 HEALTH AND THE SCHOOL 

inspectors, no system of records and reports necessary 
to insure carefulness and fidelity on the part of cus- 
todians would be regarded as useless red tape. Exact 
accounting and business-like methods are quite as essen- 
tial to the proper supervision of medical inspection as 
to the management of financial aiTairs. 

Mr. Young. — I notice that, while your system makes 
admirable provision for a record of individual exami- 
nations and for daily and monthly reports, it apparently 
does not provide for annual summaries, or for a con- 
tinuous cumulative history of the physical development 
of each child. 

Mr. Ross. — The system contemplates both of these 
provisions. The annual summaries will be obtained by 
bringing together the facts for each school, for each 
medical inspector, and for each supervisory district, and 
for the city as a whole into compact tabular form. The 
physical histories of individual children are to be per- 
manently recorded upon cards similar in most respects 
to Form i ; the main facts regarding defects found and 
corrected being entered chronologically opposite the 
proper dates. 

Mr. Young. — Are the record forms that you have dis- 
cussed all that are necessary for carrying on the busi- 
ness of medical inspection? 

Mr. Ross. — They constitute the vital part of the rec- 
ord system, unless we include sanitary inspection in the 
same system. It seems expedient in our case to have 
physicians inspect the schools as well as the children, 
and you will notice that provision was made in the 
daily service record for an account of time employed 
in sanitary inspection. We have prepared, in addi- 
tion, a form for systematizing the records of such in- 
spection. 



RED TAPE 



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RED TAPE 189 



RECORD OF INSPECTION OF SCHOOL PLANT 

Form 5 provides for both a current and a permanent 
record of facts concerning the seating, lighting, tempera- 
ture, and sanitation of each class room, and the general 
sanitary condition of coat rooms, toilets, water supply, 
and the premises generally. The form also calls for a 
record of recommendations for the correction of sanitary 
defects, and the action taken by the appropriate authori- 
ties; thus locating responsibility for any unsanitary con- 
dition that is permitted to continue. 

Now, to answer Mr. Young's question whether these 
forms are all that are necessary for carrying on the busi- 
ness of medical inspection — they are not all that are re- 
quired for carrying on the entire business, of course, but 
are the heart of it. Various supplementary devices are 
needed to facilitate the work of medical inspectors and 
economize their time. Printing is far cheaper than writ- 
ing and more easily standardized. For this reason it is 
desirable to furnish carefully worded forms for use in 
notifying parents of the exclusion of children for con- 
tagious disease ; for giving instructions concerning the 
treatment of minor affections ; and for urging the regu- 
lation of children's diet, hours of sleep and personal 
hygiene. A well-organized medical inspection service 
will also do well to issue periodical bulletins, as is now 
being done in several cities and states where parents and 
pupils are informed, one point at a time, concerning mat- 
ters of vital and timely interest. By the effective use of 
appropriate pictures, charts, and other illustrative mat- 
ter, such bulletins can enlist practically every parent in 
the community, to some extent, in a program of construc- 
tive child hygiene. By utilizing the enormous power of 
14 



igo HEALTH AND THE SCHOOL 

newspaper publicity, still wider effect can be given to 
"health-grams" and to a community program of health 
conservation. 

Mrs. Ross. — I will frankly confess that this evening's 
discussion has given me a new sense of the value of 
forms of recording the observations and service of medi- 
cal inspectors. It is evident that those who apply the 
term "red tape" to a well-considered plan for collecting, 
classifying, and summarizing these facts simply advertise 
their own ignorance of the basis upon which all efficient 
management must rest. 

Mr. Young. — Certainly without the constant applica- 
tion of fact-tests the best laid plans may come to naught. 
By the intelligent use of such tests, good intentions may 
be transformed into substantial results and praiseworthy 
enthusiasm into scientific certainty. 



SUGGESTED READING 

Allen. Efficient Democracy. Chapters V-VH. 

GuLiCK AND Ayers. Medical Inspection of Schools. 
Appendix H. (In editions previous to 19 13.) 

Snedden and Allen. School Reports and School Effi- 
ciency. 



XI 

HEALTH BEGINS AT HOME 

Mr. Young. — Alert school physicians, perfect school 
sanitation, the wisest curriculum that can be devised — 
these agencies seem to herald a day of new vigor and 
joy to our children. But they are not enough. Our 
children still spend more than half their time at home. 
Bad conditions there can counteract to a large degree 
the best efforts of an enlightened public school system. 

When we heard the startling figures in the report on 
the Washington school the fact did not escape us that, 
if the school was harboring 87 unsound children in every 
100, the homes were doing the same thing, and possibly 
even creating defects just as the school has been doing. 

Our recent work with parents in securing medical 
treatment for their children has incidentally convinced 
us that the homes are indeed responsible for many of 
the children's defects. Mrs. Ross will report to us on 
the observations made by the nurses.* 

Mrs. Ross. — In locating home responsibility for the 
defective children we had to find out two very essen- 
tial things — what homes showed most defective children, 
and how such homes differed from the others. Our 
nurses accordingly, after they had finished their special 
work of securing medical treatment for the defective 

* Based upon an examination of home conditions of New York 
school children by the New York Committee on Physical Wel- 
fare of School Children, 1907. 

igr 



192 HEALTH AND THE SCHOOL 

children, made visits to all the remaining homes of the 
Washington school children. 

The children of this school come from a great variety 
of homes, representing all grades of prosperity and in- 
telligence, and we supposed that these various grades 
would be clearly reflected in the various health condi- 
tions of the children. Our surprise was great, there- 
fore, when we found but little difference in the physical 
condition of the children whether they came from homes 
of opportunity or of neglect. 

Adenoids and anemia were almost as frequent on the 
boulevard as in the alley. Even malnutrition was com- 
mon in the prosperous homes, the ill effect of wrong 
feeding or overfeeding in these homes equalling in many 
cases the ill effects of underfeeding in the poor ones. 
In the better homes, it is true, there was more evidence 
of money outlay for the children's health. The doctor 
was constantly being consulted for this and that, but, in 
spite of this advantage, the proportion of thoroughly 
healthy children in the better homes was only slightly 
greater than in the poorer homes. In fact, we found but 
few children really sound and well in any of the homes 
of rich or poor, and we were almost led to believe that 
childhood is a disease and that the normal condition of 
children is to be forever passing from one ailment to 
another. One mother, indeed, seemed to regard this as 
the case when she said placidly, "Yes, the babies have 
been sick most of the winter, but one can't expect little 
children to be well much of the time." 

This woman was bringing her wealth, her college 
education, her time, and her devotion to bear on the 
rearing of her children; but she was not keeping them 
well, and so supposed they couldn't be kept well. On 
inquiry she admitted that she had never made a study 



HEALTH BEGINS AT HOME 193 

of the hygiene of childhood. This admission furnished 
the key to her children's ill health, which was not due 
to any inherent weakness of childhood. In fact, these 
children had unusually strong constitutions, being en- 
dowed with a rare physical heritage. What they needed 
was a hygienic regime which their mother did not know 
how to provide. 

This case is not the exception ; it is thoroughly typical 
of the households that came under our survey. Our 
inquiry, which we made at every house, as to whether 
any systematic study of child hygiene beyond the infant 
stage was being or had been carried on, usually caused 
bewilderment, and in only one instance met an affirma- 
tive response. 

In several homes, it is true, we found that the health 
of children was recognized as a problem, and some 
thought was given to it, but this subject of inquiry 
ranked distinctly lower than the absorbing question of 
the style of clothes most becoming to their young per- 
sons. One column of health hints to 20 pages of fashion 
hints per month seemed a satisfactory arrangement to 
most of the mothers who showed any interest at all in 
studying the health of their children. 

In one exceptional case we found the mother making 
a thorough study of child hygiene. She declared that 
bringing up healthy children was a fine art — a compli- 
cated art which must be faithfully studied to be mas- 
tered. She was taking a magazine devoted to the sub- 
ject of health, and reading in addition whatever she 
could find that bore on the healthful upbringing of her 
three young sons. The diet, the air, the dress, the 
sleep, the exercise, the work, and the play for these 
young boys were provided according to the best stand- 
ards to be found, with results that any mother would 



194 HEALTH AND THE SCHOOL 

envy. These boys would have carried off the blue rib- 
bon had their parents been accorded the same opportu- 
nity for exhibiting- their productions as we delight to 
give those talented individuals who raise excellent chick- 
ens and pigs. 

Mr. Martin. — Your irony cuts home, Mrs. Ross. My 
own children would carry off few prizes. I have not 
been so fortunate in finding ready aids for bringing up 
healthy children as this mother of sons has been. 

From time to time I have called on the experience of 
my friends who have succeeded in keeping a fair pro- 
portion of their children alive, and they have generously 
told me all they knew ; but what did they know ? One 
knew that a draft of air in pneumonia was fatal ; another 
that the patient could only be saved by putting him on 
the roof. One knew that little children must have plenty 
of meat to insure good teeth ; another knew that meat, 
even in small quantities, was a poison. One knew that 
water at meals ruins children's digestion; another knew 
that children couldn't drink too much water at any time. 
One knew that flannels should be worn the year round ; 
another knew they were never needed. I have tried to 
avail myself of all these instructions, but, in spite of 
that, my children aren't very well, and I confess I don't 
know how to make them so. 

Mrs. Ross. — Mr. Martin's experience illustrates ex- 
actly the conclusion that our committee was forced to 
draw, which was that few parents understand the physi- 
cal care of children, and that almost none realizes that 
child hygiene is a scientific art which it is a duty to 
practice. It is not poverty, overcrowding, or insufficient 
food that is mainly keeping the mass of children in low 
health. It is ignorance. I could multiply instances of 
appalling mistakes we found not only in ignorant homes, 



HEALTH BEGINS AT HOME 195 

but in those of supposedly highest intelligence and cul- 
ture. 

We found, for instance, the gifted child of a brilliant 
statesman suffering from malnutrition. The child was 
on a double diet which the parents, under doctors' or- 
ders, were forcing on him in the hope of increasing his 
scanty number of pounds. The solicitous parents did 
not observe that the child was scarcely chewing his food 
but bolting it down in quantities at top speed ; and so it 
never occurred to them that the excessive food in its 
unmasticated state was continuing to cause the very 
condition it aimed to correct. It is probable that the 
little boy's health would be completely made over if he 
merely acquired the habit of chewing his food well. 

Another family we found mourning the death of an 
only daughter. The little girl, whose adenoids had been 
neglected, had just died from pneumonia caused by 
ether irritation during an operation for appendicitis. 
The doctors were convinced that this rare complication 
would not have occurred if the respiratory membranes 
had been kept clear and sound. 

In another family we found a little boy on the verge 
of a nervous breakdown. The father was urging him 
with promised rewards to make further efforts in school. 
When a friend invited the child to her seashore home 
to spend a few days of rest and play the father would 
not consent because the visit would interrupt the all- 
important school work. Just a little further strain is 
likely to put a permanent end to this child's school 
work. 

In another home we found a baby dying of enteritis 
because its grandmother thought that this modern talk 
about the necessity of sterilizing all the bottles and 
nipples was nonsense. 



196 HEALTH AND THE SCHOOL 

Shall I continue my woeful story, or have I made it 
clear that, as a rule, our homes are not caring for chil- 
dren according to established hygienic principles, and 
that the health of our children would profit infinitely 
if they were? 

Mr. Martin. — You have made your point very clear, 
Mrs. Ross. It is in thorough accord with my own ex- 
perience. To be sure, my acquaintances all have hy- 
gienic principles, but they are not established ones ; many 
of them are mutually exclusive. So far as I know, the 
raising of children has not been standardized, as the 
raising of hogs, calves, or chickens has been. The con- 
ditions necessary for the health of chickens, for instance, 
are thoroughly understood, and can readily be found 
in any chicken magazine or special government bul- 
letin. 

My fourteen-year-old boy, who is starting a fortune 
on hens in the back yard, has a great advantage over 
me, who am trying to raise him. The boy can read 
enough in one afternoon to. insure his winning all the 
prizes at the county fair — provided he carries out in- 
structions. But I, who am raising children, what guide 
have I to compare with these valuable instructions on 
chickens? If I could come upon a few principles that 
didn't contradict one another, that had a scientific foun- 
dation, and that were warranted to stand wear, I would 
exchange my whole library for them. 

Dr. Latta. — The case is not so desperate as that, Mr, 
Martin, though the government would certainly increase 
its claim to our respect by elevating the art of child- 
raising to the level of chicken or corn-raising and put- 
ting the best method of child culture within the reach of 
every American parent. Indeed, the country has already 
begun to advance in this matter. It is going out of fash- 



HEALTH BEGINS AT HOME 197 

ion for a state to appropriate $150,000 for the protection 
of the health of its people and $750,000 for the protec- 
tion of its fish, forests, and game, as the Empire State 
did a few years ago. We have strong reason to believe 
that the new national Children's Bureau is opening a 
new era for the health of the nation's children. The 
Bureau has already attacked the evil which presses most 
bitterly on the homes of our country, the needless death 
of hundreds of thousands of babies and little children 
each year. 

While, as Mr. Martin says, the government has until 
recently neglected the matter of children's health, the 
medical profession has not. Sound standards for bring- 
ing up healthy children have actually been established, 
and these have the great virtue of being simple and 
easily mastered. 

Mr. Martin. — Then why aren't they known? Why 
don't the doctors instruct us? Why do they studiously 
envelop their services in a shroud of mystery? Why 
is it a breach of etiquette to inquire what drug is about 
to go into your child's stomach, and another breach, 
when you see the new doctor entirely reversing the last 
one's treatment, to ask whether the old doctor was kill- 
ing your child? Why does the physician say in effect, 
when he comes into your house, "This is my case. 
'That is all ye know on earth and all ye need to know.' " ? 

Dr. Latta. — That old-fashioned medicine-man trick- 
ery has nothing to defend it, sir, except that the public 
encourages it. I am glad to hear a protest made against 
it. If the people would insist on being treated as in- 
telligent beings by physicians, and insist as well on a 
display of intelligence by their physicians, the cause of 
health would be enormously advanced. If you would 
help this on, encourage the doctors and the medical 



198 



HEALTH AND THE SCHOOL 



schools that do not regard the duty to a family done 
when a temperature has been taken and a dose pre- 
scribed. 

Mr. Martin. — Just how is one to encourage such doc- 
tors? The advice of a physician is expensive. Most 
families feel that they cannot afford it unless the case 
is urgent. Few people can manage to call in a costly 
private advisor for all the questions that arise in the 
care of children. Is there no simple way of arriving 
at the established principles of hygiene for which we 
are all groping? 



WHICH OF THESE COWS*) 

DO YOU GET YOUR MILK FROM ! 




IF TOU DONT 



Ask iHE HCAUffl DnrARTMEItT TO GIVE YOU THE RECORD OPTOH? NILKNflN. 
Tftsteurize your rm\k At borne to be on the 6f^e 6ide. 



AN APPEAL THAT LEAVES FEW PARENTS UNINSTRUCTED OR INDIF- 
FERENT. 

Dr. Latta. — There surely is. Well-selected reading 
should put the main principles of hygiene within the 
reach of any fairly intelligent person. It is' important 
to have such reading directed under competent advice, 
however, as much of the health literature that appears 



HEALTH BEGINS AT HOME 199 

in newspapers and periodicals has little value, being ill 
related, unscientific, and even contradictory. Public 
health officers should give advice in such matters, as 
well as instruction to the people in simple hygienic prin- 
ciples. Ex-Health Commissioner Evans of Chicago, 
when he began to publish his weekly "Health-grams," 
set a great example to the entire country in practical 
methods of teaching the people to understand such im- 
portant matters as the care of young babies, the handling 
of contagious diseases, the danger of flies, the value of 
fresh air, clean milk, and pure food. The state Health 
Almanacs recently published in Virginia and Kansas are 
also notable examples of forceful and far-reaching pub- 
lic instruction. The observance of Health-day in a num- 
ber of states has also proved to be a powerful means of 
directing tlije attention of entire communities to the study 
of health. 

A method which has proved very successful in im- 
pressing great numbers of people is based on the Mis- 
souri idea of actual demonstration. The various wel- 
fare shows held in several cities recently, the Child Wel- 
fare Exhibits in New York and Chicago in 191 1, 
the Milk Show in Philadelphia in the same year, and 
the remarkable Philadelphia Baby-saving Show in 
1912, have reached hundreds of thousands of people 
eager to learn the best standards for rearing their 
children. 

Miss Parsons. — Another very effective agency for 
demonstrating health principles to parents is the hy- 
gienic school lunch, an institution now successfully es- 
tablished in over 40 of our cities. The interest which 
the schools show in the matter of feeding children, and 
the benefit which the children derive from the lunches, 
impress parents profoundly with the importance of a 



200 HEALTH AND THE SCHOOL 

properly selected diet. The most progressive schools are 
taking- advantage of this aroused interest to give parents 
direct instruction in the subject. We must not lose sight 
also of the immensely valuable health instruction that 
can be given to parents by teacher nurses under school 
direction. The intimate and continuous touch of these 
nurses with home life in their districts makes their serv- 
ices among the most important factors in advancing a 
knowledge of hygiene among parents. 

Dr. Latta. — In addition to such public work as we 
have cited, there should be constant instruction carried 
on by private practitioners. I myself am about to con- 
duct some classes in hygiene among my patients. I 
cannot afford the time nor they the money for individual 
instruction ; but in these classes of twenty-five or thirty 
members we can cover the necessary ground with one 
twenty-fifth or one-thirtieth the time and money outlay 
that individual teaching would require. 

Mr. Young. — Dr. Latta in his last utterance has 
rather anticipated a proposal I was about to make. Two 
things this evening have been made very evident : first, 
that parents, as a rule, are helplessly ignorant regarding 
the requirements for their children's physical welfare; 
second, that it is the duty of physicians to help dissipate 
this ignorance. I was accordingly about to request Dr. 
Latta to give us a series of talks in which he should out- 
line a general health program. Since he is already ar- 
ranging to hold classes in hygiene among his patients, 
may I suggest that he include the members of this club 
in his plan? 

Dr. Latta. — I welcome Mr. Young's suggestion, as 
I do every opportunity for extending health instruction, 
for it is only through the education of the laity in mat- 
ters of hygiene, and to a certain extent in actual medical 




BABY SAVING SHOW — PHILADELPHIA, MAY, I912. 

This exhibit set a new standard for effective instruction in child 
hygiene. The attendance was more than 100,000. The most 
important parts of the exhibit were preserved and sent from 
place to place throughout the city after the main show closed. 
Such graphic methods will be utilized more and more in public 
instruction as their value comes to be recognized. The lower 
photograph is a nearer view of the booth shown in the left fore- 
ground of the upper picture. 




HEALTH BEGINS AT HOME 201 

matters, that we can hope to make much progress toward 
our goal of universal health. 

It is not the doctors but those who have the daily 
care of the children who really determine their health. 
The mother who does not know the few fundamental 
laws of health, or who, knowing them, fails to observe 
them, has little reason to hope that she will bring up 
all her children or have those who are spared grow up 
thoroughly healthy. On the other hand, a mother who 
does know the simple laws of health and follows them 
in caring for her children may be reasonably free from 
the haunting terror of death and disease. Health laws 
are easy to understand ; as easy as the ten command- 
ments. 

Mr. Young. — And fully as hard to keep. 

Dr. Latta. — Hard sometimes, but not so hard as to 
suffer the consequences of health laws broken, which 
are : sickness, sorrow, and loss. Too many parents have 
gained in grief the knowledge that arrived too late. The 
day has come, however, for an end to these grievously 
learned lessons. Parents are demanding to know how 
to keep their children well, and men of science are telling 
them how. 

Miss Parsons. — Are there not many conditions af- 
fecting the health of children which are out of the direct 
control of parents, such as smoke and dust in cities, 
bad school air, and adulterated foods ? 

Dr. Latta. — There surely are, and such evils can be 
attacked only by organized public effort, which it is the 
duty of all parents and public-spirited citizens to assist. 
Some of these desirable changes can unfortunately come 
only slowly, but, while parents are struggling with them, 
they can do much to offset the harmful effect of unsan- 
itary public conditions by making home conditions as 



202 HEALTH AND THE SCHOOL 

wholesome as possible, thus keeping the resisting powers 
of their children at a maximum. 

The health of children who have inherited a fairly 
sound physique depends upon two main factors: their 
environment, and their own habits. Parents of naturally 
healthy children who provide them with the right en- 
vironment and help them to establish wholesome habits 
are bestowing upon them a peerless heritage of power 
and happiness. The necessary elements in the environ- 
ment are few, but most important : shelter, air, food, 
clothing, and play space in the physical environment; 
joy, affection, and hope in the social environment. To 
provide these vital requirements for children in the right 
amount and kind is to go far toward securing for them 
robust health. The necessary habits are simple: to keep 
the body clean, to eliminate waste regularly and com- 
pletely, to masticate food thoroughly, to aspire, work, 
love, play, exercise, and rest in the proper degrees. Such 
a regime carried on in wholesome surroundings is the 
guarantee of a healthy, vigorous life. 

The details to be considered in carrying out this 
health program will form the basis of our discussions in 
the talks which Mr, Young has asked me to give. 

Suggested Reading 
Bureau of Municipal Research, Philadelphia. 

Report of the Philadelphia Milk Show. 

Report of the Philadelphia Baby-saving Show. 
Child Hygiene Association, Philadelphia. 

Report of Philadelphia Baby-saving Show. 
Denison. Helping School Children, Chapters VI-IX. 
Grice. Home and School. 
Saleeby. Parenthood and Race Culture. 
State Health Almanacs of Virginia and Kansas. 



XII 

AIR 



Dr. Latta. — One of the first and most pressing needs 
of all creatures is shelter, an arrangement which civil- 
ized man has unfortunately carried to great excess. De- 
vised in the first place to protect against the destructive 
elements, storm and burning sun, it has come to be 
throughout the temperate zone a barrier to the life-giv- 
ing sunlight and air. The problem of shelter is not 
how we can be sufficiently protected by it, but rather 
how we can keep from being destroyed by it. Substan- 
tial answers to this question have been found in the 
now popular sleeping porches and window tents, open- 
air schools, and boys' and girls' camps, all of which are 
devices for securing the most urgent of all human needs, 
fresh air. A man can make shift to live a little while 
without either shelter, clothes, or food. Not so if his 
air supply is withheld. In that case he promptly dies. 
Nature has provided liberally for this most pressing and 
constant of all the vital necessities, making fresh air 
more abundant than any other life-giving element. 

This very abundance of air in nature has unfortu- 
nately led man to think lightly of its value. In the days 
of Queen Elizabeth, when building fine houses became 
the rage, Englishmen shut out the wholesome airy drafts 
from their houses and then began to die of tuberculosis, 
as they have been doing ever since. To this day 

203 



204 HEALTH AND THE SCHOOL 

the matter of proper house ventilation lags far behind 
the other provisions of sanitation. Bad sewage, for 
example, in Chicago, a city of 2,250,000, is estimated 
to be causing less than 400 deaths a year, while the an- 
nual army of victims from bad ventilation numbers 10,- 
000. In the words of ex-Health Commissioner Evans, 
"Man consumes solid food, liquid food — water, and 
gaseous food — -air. Ten thousand deaths a year from 
bad meat, or bad milk, or bad water would produce a 
world-wide scandal, yet we accept ten thousand deaths 
a year from bad air with complacency." 

Mr. Ross. — How are those figures arrived at ? I have 
never happened to see in a mortality list a death re- 
ported as caused by bad air. 

Dr. Latta. — Foul air deaths are never so reported, 
yet there they stand, bulking about 40 per cent, in every 
death column. The immediate causes of these deaths 
are given as tuberculosis, pneumonia, grippe, bronchitis, 
spinal meningitis, scarlet fever, every one of them air- 
borne diseases. The numbers that die from these dis- 
eases are appalling. Do you know that 50 per cent, of all 
who die in this country between the hopeful ages of 20 
and 30 years die of tuberculosis, and that pneumonia now 
claims almost as many victims annually as tuberculosis, 
the total roll from each disease being not far from 
160,000? 

Miss Parsons. — I suppose the number of deaths from 
these diseases, large as it is, indicates but a small pro- 
portion of the entire number of bad air victims. There 
must be many more who recover from these diseases and 
who pay bitterly in suffering and financial loss, as do 
their friends. 

Dr. Latta. — Obviously. For every death from tuber- 
culosis it is estimated that there are not less than five 



AIR 205 

living cases, some of them hopelessly doomed, others 
destined to make a long, agonizing struggle back to 
health. The number of people in the United States suf- 
fering from tuberculosis is probably over 1,000,000. 
Half of these are able to earn about half their wages, 
the rest are totally incapacitated. The cost of these 
cases in loss of wages, cost of treatment, and capitaliza- 
tion of the earnings cut off by death is annually $1,235,- 
000,000. Much of this loss is suffered by the families 
which are left destitute. 

Mr. Ross. — I am still puzzled to know why you call 
the diseases you have mentioned foul air diseases. Are 
they not all caused by bacteria ? What has bad air to do 
with them? 

Dr. Latta. — A great deal, sir. The bacteria that 
cause the diseases I named, all of which begin in the 
respiratory organs, can be carried by dust in the 
air. What we call bad air — indoor air that is not con- 
stantly changed — is invariably full of harmful bac- 
teria. 

Mr. Ross. — What is to prevent these same bacteria 
from inhabiting the outer air? 

Dr. Latta. — The sunshine. The sun is the greatest 
natural germicide. Tuberculosis and a host of other 
germs cannot survive an application of sunlight. 

Mr, Ross. — Then do I understand that the single 
great menace of indoor air is its large number of bac- 
teria ? 

Dr. Latta. — That, along with indoor dust which car- 
ries bacteria, is certainly the most dangerous element in 
house air, but it is only one of several others, such as 
undesirable temperature and humidity, organic poisons, 
poisonous gases, and insufficient oxygen. All these un- 
favorable elements lower natural human resistance to 
15 



2o6 HEALTH AND THE SCHOOL 

disease. Thus, as you see, unchanged indoor air is doubly 
dangerous because it is not only loaded with germs, but 
prevents people from resisting them. Children, whose 
natural power of resisting disease is much lower than 
that of adults, are never really healthy unless their lives 
are spent mostly in the open air. 

Mrs. Ross. — Do you mean that literally. Dr. Latta? 
Few children can manage to spend most of their time 
in the open air. 

Dr. Latta. — And few children, as we have been find- 
ing out, manage to be really healthy. Parents are begin- 
ning to suspect the connection between fresh air and 
healthy children, and they are asking how they can give 
their children the necessary fresh air while they are 
providing them with such fruits of civilization as the 
ordinary school house and the steam-heated flat. They 
can't do it. Parents who want to see their children red- 
blooded must either keep them out of the ordinary 
school house and city flat, or reform the arrangements 
for ventilating such places. 

Mr. Martin. — I am struck by your sweeping demand 
for children's outdoor life. How can we give it to 
them without making Indians of them? 

Dr. Latta. — It can be given to them without inter- 
fering with any of the cultural processes which the 
civilized parent so strenuously applies to his young. By 
day the semi-outdoor school, which is the school of 
the future, will answer the needs of healthy education ; 
by night the sleeping porch or window tent will pro- 
vide fresh air without sacrificing any of the refinements 
of home. 

Mr. Ross. — Now, before we get the outdoor life com- 
pletely adopted, let me ask whether it doesn't savor 
somewhat of a fad. I can't forget the robust men and 



AIR 207 

women who grew up when it was the fashion to shut 
tightly all the bedroom windows to keep out the dan- 
gerous night air. What evidence is there that indoor 
air actually induces disease and lowers resistance, and 
that outdoor air does the opposite? Can you quote us 
the figures? 

Dr. Latta. — Plenty of them, Mr. Ross. As far back 
as the civil war it was found that the unhoused hos- 
pital cases showed greater resistance to typhoid, ery- 
sipelas, and sepsis than cases of the same diseases in 
well-appointed hospitals, where the percentage of deaths 
was decidedly higher. The introduction of effective 
ventilation in children's hospitals has reduced the death 
rate from 50 to 5 per cent. ; in surgical wards of general 
hospitals from 44 to 13 per cent. ; in army hospitals from 
23 to 6 per cent. The annual death rate among horses 
in the German military service has been brought down by 
more roomy quarters and free ventilation from 19 to 1.5 
per cent. ; and in Boston, during a certain epidemic, the 
number of horses lost in badly ventilated stables was 5 
to I in those well ventilated. Fresh air renders recovery 
from disease not only more sure, but more swift. At 
the S. R. Smith Infirmary on Staten Island a comparison 
made in two wards of the same nature, containing the 
same class of patients, showed the average time of recov- 
ery in the non-ventilated wards to be 16 days, in the ven- 
tilated wards 10 days. 

Mr. Martin. — You have left us with no doubt of the 
desirability of fresh air for our children. How to se- 
cure it is the next question. 

Dr. Latta. — It is well to keep two simple rules in 
mind : 

I. Keep the children out of doors as much as possible 
day and night. 



208 



HEALTH AND THE SCHOOL 



2. Make whatever indoor air children must breathe 
as much like outdoor air as possible. 

Many people think they are strictly observing the first 
rule when they are giving their babies and children an 
outdoor "airing" of an hour or two a day. This is 




OUT-DOOR SLEEPING SIMPLIFIED. 



A small tent, hurig like an awning inside the window, leaves the 
sleeper's head in the open air, at the same time preventing the 
room from being cooled off. 



good as far as it goes, but it goes no further toward 
answering the whole need of fresh air than one glass of 
good milk a day answers a child's entire requirements 
for food. The easiest and most effective way to give 
children outdoor air is to have them sleep in it. This 
arrangement alone allows them to spend almost half of 
their time in the open air. 

Mrs. Ross. — Do you think it safe for children to use 
sleeping porches the year round? A friend of mine 



AIR 



209 



gave up the plan because her children caught so many 
colds. 

Dr. Latta. — It is probable that your friend did not 
realize the importance of protecting her children's heads 
and feet from exposure. It is perfectly safe for chil- 
dren to sleep outdoors all the year if they are sufficiently 
protected. In severe weather, if the extra precaution 
is taken to cover heads and necks with woolen hoods 
coming well over the forehead and fastening around 
the neck, and to keep the feet warm with woolen socks 
and soapstones, the north wind brings nothing but health 
and vigor in its blast. 



"^ 



r 




OPEN AIR COMFORT. 

This bag, designed by Dr. Carrington for use in out-door sleeping 
or sitting, is inexpensive and easily made at home. The first 
drawing shows the bag spread out to air; the second shows the 
blanket folded to 'form the bag; the third (on larger scale) 
shows the canvas flaps at the bottom and sides drawn into place 
and buttoned or buckled. 



Miss Parsons. — I can testify to the wholesomeness 
and pleasure of the sleeping porch. For a year I have 
slept on the roof of our settlement house. During that 



2IO HEALTH AND THE SCHOOL 

time r have felt more vigorous than ever before in my 
life, and have not contracted one cold. The neighbor- 
hood has taken up the idea, and many of the roofs are 
now dotted with little shelters where babies are becom- 
ing rosy and young men strong. Our tenement laws, 
it would seem, will soon have to provide for some form 
of sleeping porch or roof, as that is the one easy means 
of securing an abundance of air for the people in the 
congested districts. 

Dr. Latta. — That is an excellent suggestion. No 
step could be taken that would go further toward se- 
curing good health for the people. 

Now, before we leave the subject of open air arrange- 
ment it will be well to give a warning or two. There 
Should not be too much direct exposure to the cold air. 
Sleeping porches should always have fairly warm dress- 
ing rooms accessible to them, and children's play spaces 
in winter should be sunny and shielded from the win- 
ter wind. A cold wind, and especially a damp one, by 
chilling little children beyond their power of resistance, 
sets up catarrhal trouble. :; 

Mr. Martin. — Our children must still spend a fewii 
hours in the house. How are we to make the house; 
air as much like outdoor air as possible? 

Dr. Latta. — Even under present imperfect housing 
conditions this can be done far more successfully than 
is usually the case. It is necessary, first of all, to pro- 
vide for a constant entrance of outdoor air that is free 
from dust and a constant escape of indoor air by various 
means, such as open windows, doors, air flues, and open 
fire places. A house that is heated by a hot-air furnace 
has always a fair amount of fresh air circulating 
through it ; so has a house with open fires, which for- 
tunately cause a stream of fresh air to be forced in 



AIR 211 

through the cracks, even when windows have been faith- 
fully shut against the cold. 

An excellent device for securing a well-distributed 
volume of fresh, warm air in a room having a heat flue 
opening on the floor is a revolving air deflector set on 
the register. The deflector is revolved by the stream 
of warm air which it fans across the floor in every di- 
rection. 

The problem of securing a circulation of air becomes 
pressing in the houses that boast of the popular steam 
or hot-water heating systems. Such houses rarely have 
separate ventilating systems, and are at a great disad- 
vantage compared with those that employ the old-fash- 
ioned hot-air heating, which ventilates while it heats the 
house. 

In these houses and flats housekeepers must double 
their care to secure outdoor air. Windows should be 
left constantly open top and bottom with window boards 
to prevent direct drafts in every occupied room. Rais- 
ing the window from the bottom is not enough, unless 
there is a strong cross draft to an opposite window or 
room. Lowering the window from above is necessary 
to set up a current of air, the hot vitiated air escaping 
from the upper opening as the cool fresh air enters 
below. In very severe weather, when the draft from 
the open windows seems dangerous to health, occupied 
rooms should have a thorough blowing out with open 
windows and doors not less than once an hour. 

Mr. Ross. — Is not your prescription of so much out- 
door air in the house likely to run the coal bill up un- 
comfortably? 

Dr. Latta. — Oh, yes, the bill is likely to run up a 
little, though most of our houses would be more com- 
fortable if we kept them decidedly cooler by means of 



212 



HEALTH AND THE SCHOOL 



fresh air. As for the fuel, do you realize that a fair 
charge for three doctor's visits and a prescription equals 
the price of a ton of coal? If you really want to reduce 
your living expense, save on the doctor by spending 
enough for right living to make his services unnecessary. 
Mr. Martin. — Is the problem of securing good air 
in the house solved when we allow for a good circula- 
tion of air such as you have described? 




CLEAN CLEANING. 

The hand-run vacuum cleaner, built like a carpet sweeper, which 
removes dust without scattering it, is fast supplanting the 
barbarous broom. 

Dr. Latta. — Hardly. A circulation of fresh air is 
the first essential in house ventilation, but not the only 
one. Outdoor air on entering a house soon acquires 
the bad characteristics of indoor air, unless great care is 
taken to prevent this. Those baleful twins, bacteria and 
dust, are always in waiting to supply some infection, 
if no worse a one than the common house cold, which 
is, on the whole, the greatest bane of our winter months. 



AIR 213 

House dust is never free from bacteria, and should be 
avoided like the plague. 

The amount of dust in the average house could be 
greatly reduced by a more sanitary method of furnishing 
and cleaning than is generally employed. Carpets, up- 
holstered furniture, and heavy hangings should be 
shunned. Cushions and rugs should be cleaned out- 
side, or with a vacuum cleaner. Floors should be smooth 
enough to clean with cloths instead of brooms. A really 
sanitary house can be made about as clean every day as 
the old-fashioned dust-gathering house was twice a year 
in the back-breaking "house-cleaning" season. 

A few American housekeepers, remembering that use 
is beauty, beauty use, have already learned that a dwell- 
ing is not a museum for the storage of miscellaneous 
stuff, but a shelter for comfortable living. When all 
the housekeepers have acquired this idea and firmly cast 
half their house collections into the ash barrel, the cause 
of health as well as beauty will be wonderfully advanced. 

The temperature of indoor air has also an important 
bearing on its wholesomeness. In addition to the di- 
rect danger to health from exposure when the indoor 
heat in winter is excessive, a temperature above 70 de- 
grees interferes with the rising of the warm expired air, 
which instead hangs around the head to be breathed 
again and again. Air issues from the lungs at a tem- 
perature of about 90 degrees, and when the room tem- 
perature is 68 degrees or under it rises immediately 
above the breathing zone. House temperature should 
be kept between 60 degrees and 68 degrees, according 
to the activity of the occupants, those most actively em- 
ployed finding the lowest temperatures most desirable. 

Moisture, as we have previously learned, is another 
important element in wholesome indoor air. Care must 



214 HEALTH AND THE SCHOOL 

be taken to keep the relative humidity or moisture from 
becoming either too high or too low. A house should 
never be heavily shaded from the sun or set in a hollow, 
as these conditions foster dampness. The cellar should 
be kept as dry as possible by a constant circulation of 
air. When a house has been closed for a time it should 
be well dried by means of fires or warm sunshine. 

When the weather is cold enough to require constant 
fires the danger of dampness gives way to the danger of 
too little moisture. To avoid this, steam should be added 
to the heated indoor air by one means or another, except 
when the outside air happens to be very damp. When 
a hot-air furnace heats the house, fresh steam should be 
introduced into the air chamber of the furnace or directly 
into the air of the house. When stoves are used for 
heating, pans or kettles of boiling water should always 
be kept on them. When steam radiators are employed it 
is often possible to let fresh steam into the air from the 
pipes. Hot water radiators do not admit of such an ar- 
rangement and their use makes it necessary to employ 
some special humidifying device if the relative humidity 
of the air is to be kept at a proper point. Numerous and 
satisfactory kinds of humidifying apparatus are now on 
the market, and it is no longer necessary for any home 
or school to inflict the deadening effect of "burned-up" 
air on its members. 

The need of having an abundant supply of steam con- 
stantly injected into heated air to keep it at a satisfactory 
relative humidity was clearly shown by a test made a few 
years ago by Professor Loveland of the University of 
Nebraska. Taking two seven-room houses of exactly 
similar construction and heating equipment, he found that 
it required a daily amount of 64 gallons of water to 
raise the relative humidity of one house 10 per cent. 



AIR 215 

above that of the other — i. e., from 20 to 30 per cent. It 
was also shown that the ordinary furnace water pan 
exerted no measurable effect on the hygrometer what- 
ever. This instrument for measuring moisture in the 
air is simple and fairly inexpensive. It is indispensable 
for the determination of anything but the vaguest knowl- 
edge regarding the amount of humidity in the atmos- 
phere. 

There remain three things to be guarded against in 
maintaining pure indoor air : organic and gaseous poi- 
sons, and deficient oxygen. Ordinarily a free circulation 
of outdoor air through the house by the use of open 
windows or hot-air flues is sufficient to give the necessary 
oxygen, and to keep the air fairly free from organic or 
gaseous poisons. Any undue source of air contamination 
must, of course, be strictly avoided, such as plumbing 
without vents or traps, decaying organic matter in house, 
cellar, or yard, and neglected garbage pails. 

Mr. Young. — We are greatly indebted to Dr. Latta 
for his clear discussion of the meaning of fresh air. 
His words have doubtless left us all with the following 
emphatic ideas : 

That good health in children is absolutely dependent 
on a constant supply of fresh air. 

That children should have many hours in the open air 
every day and night. 

That indoor air should be made as much like outdoor 
air as possible by the introduction of a constant stream 
of outer air into occupied rooms, and further by the 
keeping of these rooms clean, that is, free from dust, 
germs, and organic or gaseous poisons. 

Am I right in emphasizing these three points, Dr. 
Latta ? 

Dr. Latta. — They are exactly the points I wished 



2i6 HEALTH AND THE SCHOOL 

to make emphatic. When the children of our land ac- 
tually come to breathe air provided in accordance with 
these principles, winter will cease to be the season of 
sickness, and colds will become as rare as smallpox. 

Suggested Reading 

American School Hygiene Association. Proceedings 
OF THE Sixth Congress. Report of the Committee 
on Heaping and Ventilating. 

Ayres. Open-air Schools. 

Carpenter. Heating and Ventilation of Buildings. 

Carrington. Fresh Air and How to Use It. 

Shaw. School Hygiene, Chapter IV. 



XIII 
FOOD 

Dr. Latta, — When a young baby is not thriving- its 
mother has one consuming purpose in Hfe — to get the 
right food for it. She knows if she fails the baby will 
die. Children as they grow older and stronger don't 
always die when they have the wrong food. They suffer 
all sorts of ills, however, and fall a prey to many dis- 
eases whose real cause, improper food, quite escapes 
the mother's detection, unless she has learned the few 
fundamental principles which should govern the diet of 
children. 

The vital effect that the right or wrong diet has on 
children has lately received striking demonstrations 
through experiments carried on in six schools by the 
Home and School League of Philadelphia.* In one of 
these schools warm lunches at a cost of 3 cents each 
were provided to 40 ill-nourished children for 3 months ; 
each child during that time having on the average 55.3 
lunches. The gain in physical strength, mental ability, 
and conduct of this group was compared with the gain 
of another similar group of 40 children in the same 
school; the latter taking no school lunches during the 
time of the test. The results of testing the two groups 
at the end of this period were as follows : 

* Annual Report of the School Lunch Committee Home and 
School League, Philadelphia, 1911. 

217 



2i8 HEALTH AND THE SCHOOL 

AVERAGE GAINS 

Weight Height Hand strength Lung capacity 

Children fed 1.78 lbs. .90 in. 4.13 lbs. ii.g6cu. in- 

Children not fed 80 lbs. . 68 in. 3.19 lbs. s . 40 cu. m. 



In favor of children fed 98 lbs. .22 in. .94 lbs. 6.56 cu. in. 

Lesson Averages Conduct Averages 
Before After Cain Before After Gain 

The forty fed 64.0 70.1 9.5 69-4 72.0 3.7 

The forty not fed 64.5 69.2 7.2 74-2 76.7 3.3 

In favor of children fed .... 2.3 0.4 

The records, as you see, show that the children who 
.were fed made greater gains than the other children in 
every item on which measurements were taken. If such 
results can be obtained by providing children with some- 
what less than one substantial meal a day, what may not 
be expected from three such meals? 

Mr. Ross. — Is not this little handful of 40 underfed 
children exceptional ? 

Dr. Latta. — By no means, sir. Picked up almost at 
random, they indicate the terrible proportion of under- 
fed children to be found in all parts of our land of 
plenty. It has been estimated from careful investiga- 
tions made in New York City that at least 1,248,000 
children in this country are suffering from under-nour- 
ishment. 

Mr. Ross. — The children of the poor, I suppose. 

Dr. Latta. — No, the surprising thing about these 
shocking figures is that the hungry children are not 
confined by any means to the homes of the poor. 

Mr. Ross. — Then why aren't they properly fed? 

Dr. Latta. — Because parents almost universally 
choose their children's diet without any special reference 
to two essential requirements — the nourishing proper- 
ties and the digestibility of foods. 

The diet must be regulated in accordance with these 




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FOOD 219 

two main requirements : ( i ) food should be nourishing, 
i. e., it should contain the right amount and proportion 
of elements; (2) it should be digestible, i. e., it should 
promote the most perfect assimilation and elimination 
possible. With these two guides to set the right course 
in feeding, mothers can weather seas of difficulties. 



I. NOURISHING FOODS 

Nourishing food provides completely for two vital 
processes in children — growth and activity. An abun- 
dance of all the food elements must be supplied to pro- 
vide the growing bones, nerves, blood, muscles, and 
other tissues with their needed materials. The surpris- 
ing hunger of growing children is normal. They need 
more food to their weight than grown people do. Not 
only do they require much tissue-forming food, but, on 
account of their great natural activity, a large amount 
of strength-supplying food as well. If a child is lan- 
guid or is said to have "outgrown his strength," he is 
either suffering from some physical defect or from an 
improperly balanced diet. 

Mr. Martin. — What foods go to forming tissue and 
what to supplying strength, and in what amounts and 
proportions should they be provided? 

Dr. Latta. — The body-building foods fall for the 
most part under one group — the proteids, or nitrogenous 
foods; the heat and energy-producing foods under two 
heads, called the carbohydrates and fats. The following 
is a classification of our common articles of food ac- 
cording to their body-building or strength-supplying 
properties. The table indicates when a food in one class 
contains elements in another. 



220 



HEALTH AND THE SCHOOL 



CLASSIFICATION OF FOODS * 

I. PROTEIDS — BODY BUILDING MATERIALS 



Meats (fat) 

Milk (fat and sugar) 

Cheese (fat) 

Eggs (fat) 

Fish (fat) 

Nuts (fat) 

Beans and Peas (starch) 



NON-NITROGENOUS GROUP- 

I. Carbohydrates 
A. Starches 



-HEAT AND ENERGY MATERIAL 



(a) Cereals (protein) 

(b) Bread (protein) 

(c) Macaroni (protein) 

(d) Rice (protein) 

(e) Potatoes 

(/) Sweet Potatoes (sugar) 
(g) Fruits (sugar and mineral salts) 
(h) Green Vegetables (mineral salts) 
B. Sugars 

(a) Various Sugars 

(b) Syrups 

(c) Honey 

(d) Sweet Fruits 

(e) Milk (pro'tein and fat)^ 
2. Fats 

(a) Meat Fat 

(&) Fish and Vegetable Oils 

(c) Cream 

(d) Butter 

(e) Milk (protein and sugar) 

NOTE: — Mineral salts, which are also indispensable food ele- 
ments, have not been put in a separate class in this table. As 
they are present in small quantities in all foods, it is unnecessary 
to note the fact in each case. They exist in the largest amount 
in fruit and green vegetables, which gives these foods a special 
value. 

* Based in part upon a classification of foods in The Health In- 
dex of Children, by E. B. Hoag. 



FOOD 221 

Mrs. Ross. — With the foods thus arranged in classes, 
in what proportions are we to draw on them to satisfy 
the needs of a growing child? 

Dr. Latta. — In every lo parts at least 8 should be 
selected from the energy-supplying foods, about 7 of 
these being taken from the carbohydrates (starches and 
sugars), and a little over i part from the fats. Slightly 
less than 2 parts of the entire diet should be selected 
from the proteids for tissue-building. 



Sugar 



White bread 



White potatoes 

m I 



Peanuts 

I 



Prunes 

■ 



Milk 

HZ) 

Salt pork 
Beef round 

ED 

Chicken 
Cabbage 

D 

Bananaa 



Building materia! Heating and strengthening material 

FOOD VALUES THAT CAN BE BOUGHT FOR TEN CENTS. 

The amount of tissue-building material and of heat- and strength- 
giving material in ten cents worth of certain common food 
stuffs. 

16 



222 HEALTH AND THE SCHOOL 

To make this more concrete, let us see what actual 
amounts of these various foods should be given to chil- 
dren between 8 and 12 years old. A child of such age 
should have in all not less than 4 pounds of food per 
day, 2 pounds of this being milk. Referring to our 
classified list of foods, we notice that milk appears 3 
times. Its rich supply of the three main food elements 
gives it a prominent place in each class, and makes it 
the most nearly perfect single food for children. It pro- 
vides over a third of the necessary protein and over a 
quarter of the necessary carbohydrates and fats. 

In addition to the 2 pounds (quart) of milk, the diet 
of a child between 8 and 12 should contain about 28 
ounces from the carbohydrate group, i or 2 ounces from 
the fat group, and about 3 ounces from the proteid 
group. The supply of proteids seems low in our table, 
but it must be remembered that considerable amounts 
O'f protein are contained in the carbohydrates which 
make up the rest of the diet. This simple diet table, to- 
gether with a simple cost table, are sufficient guides in the 
choice of food elements for any busy mother who does not 
care to perplex herself with further intricacies connected 
with the chemical composition of food. 

The following bills of fare for children from 2 to 12 
years old show a wholesome diet, chosen with reference 
to the proper proportion of food elements as well as 
their digestibility. These meals have been planned to 
feed three children in a family with an $800 income. 
Wholesome luxuries in the form of fresh fruits and 
vegetables, cream, olive oil,' ripe olives, etci, can be 
added at increased expense. 



FOOD 



223 



MEALS FOR ONE DAY* 

FOR THREE CHILDREN IN A FAMILY WITH AN EIGHT 

HUNDRED DOLLAR INCOME 



Child 2-4 Years Old 
Breakfast: 7.30 A.M. 



Oatmeal Mush 
Milk 

Stale Bread 
Orange Juice 

Lunch : 
Milk 

Stale Bread 
Butter 

Dinner: 
Baked Potato 
Boiled Onions 

(Mashed) 
Bread and Butter 
Milk to Drink 
Baked Apple 



Supper: 5.30 P.M. 

Boiled Rice i Cup 

Milk ■34 Cup 

Bread and Butter i Slice 

WEIGHT AND COST OF 
FOOD FOR DAY 



0.8 oz. Dry Cereal 
iVi Cups 

I Slice 

4 Tablespoons 

II A.M. 
I Cup 

I Slice 

I Teaspoon 

1. 00 P.M. 



Slice 
Cup 



Material 
Rolled Oats. . . 
Stale Bread . . . 
Orange Juice . . 

Butter 

Potato 

Onion 

Apple 

Sugar 

Rice 

Milk 



Weight 

oz. Cost 
0.8 $0.0030 

2.0 0.0080 

2.0 0.0150 

o.s O.OIIO 

2.6 0.0020 

i.o 0.0030 

2.0 O.OIOO 

0.2 O . 0006 

1.0 0.0050 
34.4 (i qt.) 0.0800 



46.7 



.1377 



Child 4-8 Years Old 
Breakfast: 7.30 A.M. 



Oatmeal Mush 
Top Milk 
Stewed Prunes 
Milk to Drink 
Toast 



Dinner: 

Pea Soup 

Croutons 
Boiled Onions 
Baked Potatoes 
Molasses Cookies 



I H oz. Dry Cereal 

J^ Glass 

4 or 5 

I Scanty Cup 

I Slice 



1. 00 P.M. 
I Cup 

1 Slice Bread 

2 Small 
I Large 



Supper: 5.30 P.M. 
Cream'Toast 2 Slices Bread 

Rice Pudding with 

Milk and Sugar i Cup 
Milk to Drink ?4 Glass 

WEIGHT AND COST OF 
FOOD FOR DAY 
Weight 
oz. 



Material 
Rolled Oats. 

Prunes 

Milk 

Bread 

Peas — Split . 

Onions 

Sugar 

Potato 

Cookies 

Rice 

Butter 



1 .0 
50 



S3-S 



Cost 
$0.0045 

O.OIOO 

0.0800 

0.0120 

o . 0046 

0.0120 

o . 0046 

0.0039 

o . 0040 

0.0050 
O.OIIO 

$0 . 1496 



SUBSTITUTES OR ADDITIONS 

For rolled oats or rice: other cereals, 
such as rolled wheat, wheaten grits, 
farina, hominy, corn meal, shredded 
wheat and corn flakes. 

For orange juice and baked apple: 
prune pulp or apple sauce. 

For onions: spinach, strained peas, 
stewed celery, carrots, or cauliflower 
tips. 

An egg may be added every day, and 
should be included at least two or 
three times a week. 

These changes will alter the cost 
somewhat. 

♦Planned by Mary Swartz Rose, Assistant Professor of Nutrition, School of 
Household Arts, Teachers College. Teachers College Bulletin, Second Series, 
No. 10. 



SUBSTITUTES OR ADDITIONS 

For rolled oats: other cereals as sug- 
gested in opposite column. 

For onions and peas: strained dried 
beans; other vegetables carefully 
cooked; fresh lettuce. 

For prunes: fresh ripe apples, baked 
bananas, other mild fruits well cooked. 

For rice pudding: junkets, custards, 
blanc mange, bread puddings and other 
very simple desserts. 

For cookies: gingerbread or sponge 
cake. 



224 



HEALTH AND THE SCHOOL 



III. 

Child 8-12 Years Old 
Breakfast 
Oatmeal mush or i J^ oz. dry cereal 

Top milk M Glass 

Stewed Prunes 6 or 7 

Toast 2 Slices 

Milk to drink M Glass 



Luncheon 


Pea soup 


I Cup 


Boiled Onions 


2 small 


Baked Potato 


I Large 


Bread and butter 


2 Slices Bread 


Molasses cookies 


3 cookies 


Dinner 


Baked haddock 


Small serving 


Creamed hashed 




potato 


H cup 


Spinach 


Vi Cup 


Bread and Butter 


2 Slices 


Rice pudding, milk 




and sugar 


I Cup 



IV. 

Suggested Dietary for Child Who Will 

Not Drink Milk. Age 5 Years 
(i quart of milk concealed in the menu.) 



Breakfast: 7 A.M. 



Oatmeal 



Creamy Egg on 
Toast 



Cocoa 



M Cup Cereal 
Cooked in i Cup 
Milk 

I Egg Yolk with J4 
Slice Bread and 
M Cup Milk 

I Tsp. Cocoa and 
H Cup Milk 



Luncheon: id A.M. 
Zwiebach and 

Cream i Piece Zwiebach 

and I Tbsp. 
Cream 

Dinner: 1.30 P.M. 
Spinach Soup 4 oz. 

Baked Potato with 

Cream i Potato and 2 

Tbsp. Cream 
Bread and Butter i Slice 
Caramel Junket i}^ Cups 



Supper: 
Rice and Prunes 



Zwiebach 



S.30 P.M. 

2 Tbsp. Rice cooked 
in H Cup Milk 
and 5 Prunes 

I Slice 



WEIGHT AND COST OF 
FOOD FOR DAY 



Material 



Weight 



oz. 

Rolled Oats i.S 

Prunes 2.0 

Milk 34-4 

Bread 6.0 

Butter i.o 

Peas — Split 1.0 

Onions 4.0 

Sugar 1.0 

Potatoes 8.0 

Cookies i .5 

Rice I.S 

Haddock 2.0 

Spinach 2.0 

65.9 



OF 

Cost 


$0.0060 





0150 





0800 





0246 





0220 





0046 





0120 





0036 





0032 





0060 





0075 





oois 





oois 


$0 


187s 



WEIGHT AND COST OF 
FOOD FOR DAY 



Material 



Weight 



Oatmeal 0.9 

Egg Yolk o.s 

Cocoa 0.1 

Zwiebach 0.8 

Toast 0.7 

Spinach Soup 4.2 

Potato 4.0 

Rice 1.0 

Prunes 1.3 

Milk 34.2 

Sugar 0.4 

Butter 0.2 

48.3 



Cost 

$0.0030 
0.0150 

0.0025 

0.014s 
0.0027 
0.0162 
0.0032 
0.0050 
o.oioo 
0.0800 
0.0013 
o . 0036 

$0.1570 



SUBSTITUTES OR ADDITIONS 

For rolled oats: other cereals thoroughly cooked. 

For haddock: rare beefsteak, roast beef or mutton chops; other fish, espe- 
cially white varieties. 

For prunes: any mild ripe fruit uncooked or cooked. 
For onions: string beans, stewed celery, beets, squash. 
For peas or spinach: turnips or cauliflower. 



FOOD 225 



2. DIGESTIBLE FOODS 

We have learned what amounts and proportions of 
food elements go to make a nourishing diet for children. 
This is only half the problem of diet. To make sure 
that the diet which contains the right amount of nour- 
ishment is digestible is fully as important a matter. 
Children's stomachs are not so strong as those of grown 
people. That is why digestive upheavals constitute the 
most numerous afflictions of young children. These are 
due in almost every case to the ignorance or careless- 
ness of mothers. If mothers would observe just two 
fundamental rules for selecting a digestible diet for 
their children, they would go far toward securing for 
them steady health and comfort. These rules are simple. 

A. The diet should be made up of food easy to as- 
similate. 

B. The diet should promote elimination of all waste 
matter by stimulating the bowels to thorough action. 

A. Foods Easily Assimilated. — Their Selection and 
Preparation. — Foods that are easy for almost all children 
to assimilate are milk and small quantities of cream, 
well-cooked cereals, baked potatoes, fresh eggs, and mild 
fruits, green vegetables, and well-baked bread with 
butter. 

Milk stands first as a food for children of all ages, 
not only because of its highly nutritious properties, but 
because of its ready digestibility. Children should not 
be encouraged to dislike milk. Now and then a rare 
child feels an actual aversion to raw milk and is unable 
to digest it, but he can usually be made to assimilate the 
proper amount (i quart per day) by its use in cooking, 
as in puddings and soups. 



226 HEALTH AND THE SCHOOL 

Cereals, if properly prepared, are easy of digestion. 
Those obtained from the whole grain, such as rolled 
oats and wheat, are preferable to the finer preparations, 
such as farina and cream of wheat. The dry cereals of 
known purity, such as shredded wheat, corn flakes, 
puffed wheat, and granose biscuit, tend to promote bet- 
ter digestion than the "mushes," because they compel 
thorough chewing. 

Eggs to the amount of one a day are easily digested 
if they are fresh and soft-boiled (they should never be 
fried). They can be used to good advantage in cus- 
tards, bread puddings, and simple desserts, as well as in 
soups. 

Fruits, which are a daily necessity for all children, 
must be selected according to the age of the children. 
For those between i and 4 years old the fruits should 
be limited to orange juice, baked apples, and prune pulp. 
The older children can easily digest any mild fresh fruit 
in perfect condition or stewed, dried fruits, such as 
dates, prunes, seedless raisins, and figs. The dried 
fruits should all be cooked without sugar, as they con- 
tain large amounts of fruit sugar, which is much more 
digestible than cane sugar. Bananas and apples that 
are baked are more digestible than raw ones. The in- 
digestibility of uncooked bananas, however, can be 
largely overcome by scraping off their soft granular 
surface, which is composed of raw starch. 

Fresh vegetables, another necessary item in the daily 
diet, are easy of digestion when properly selected and 
prepared. The youngest children should have the mild 
flavored ones, as carrots, spinach, and string beans, 
which should be thoroughly cooked and rubbed through 
a sieve or finely mashed. The older children, who do 
not need their vegetables mashed, can have celery, 



FOOD 227 

onions, cauliflower, turnips, and squash in addition to 
the vegetables allowed to younger children. 

Bread, a constant necessity in a child's diet, is readily 
digested if thoroughly baked and at least a day old. 
Corn bread, brown bread, graham and whole wheat 
breads are desirable variations on the staple white loaf. 
Zwiebach and toast, if thoroughly dried, are more di- 
gestible than ordinary white bread, as the second bak- 
ing converts the starch into dextrose, a form of sugar 
very easy to digest. 

Meat is not included in the list of foods easily assim- 
ilated, as it is a distinct tax to the digestion of children 
under 8 years old. Even for the older children, who 
may have meat in small quantities, it is well to provide 
as many meat substitutes as possible ; for meat, though 
nourishing, tends to develop putrefactive poison in the 
intestines, thus inducing fatigue. Among the numerous 
good meat substitutes are the following: skim milk, 
cheese (preferably cottage cheese) which is as rich in 
protein as whole milk, beans, eggs, nuts — ground or thor- 
oughly chewed — and prepared vegetable proteids. A 
little caution is necessary in the use of beans, cheese, 
and nuts, which must be taken in small quantities ac- 
cording to the digestive capacities of individual children. 
It should also be remembered, when it is desired to cut 
down the amount of meat, that oatmeal, macaroni, rice, 
and gluten flour contain more protein than potatoes or 
white flour. 

White fish of various sorts are distinctly more diges- 
tible than meats. Soup meat also is more wholesome 
than juicy meat, as it has been deprived of its uric acid- 
forming elements, and has still all its protein left. 

Mrs. Ross. — Will you not tell us specifically what 
foods to avoid giving to children? 



228 HEALTH AND THE SCHOOL 

Dr. Latta. — Assuredly. I have already spoken of 
meat as being undesirable for children under eight. In 
the same condemned list stand fried foods, pastry, fresh 
rolls and bread, syrups and preserves, candy, except in 
small amounts at meals, and cake, except in small quan- 
tities in the form of cookies, sponge-cake, and ginger- 
bread. No tea, coffee, beer, lemonade, or soda water 
should be given. Children over six may drink weak 
cocoa made with milk. 

Mr. Ross. — Why limit the candy so strictly? If sugar 
supplies strength, why is not candy a good food? 

Dr. Latta. — Because cane sugar, from which candy 
is made, can be digested only in small quantities. One 
more word as to the foods which I have recommended 
as easily digestible. These cannot, of course, be ex- 
pected quite to digest themselves. The children must 
do their part by faithfully chewing their food; the 
mothers theirs by avoiding monotonous routine in ar- 
ranging meals. 

Variety in diet has a marked effect upon its digestibil- 
ity. The food elements, it is true, should be provided 
in constant proportion, and but few articles should be 
supplied at a single meal, but within a week the articles 
should vary greatly. Surprises and special treats at the 
table give children wonderful pleasure, thereby stimulat- 
ing their digestion in marked degree. 

Indeed, the greatest of all aids to digestion is an at- 
mosphere of good cheer, for the nerves that govern di- 
gestion are powerfully affected for good or bad by the 
state of mind. A scientific diet is powerless to secure 
a good digestion if children are not happy at their meals. 
For either parents or children to bring anything but 
hopefulness and good-will to the table should be re- 
garded as a family crime, which strikes at the health 



FOOD 229 

of every member. The crowning touch of wholesome- 
ness which a mother can add to the carefully selected 
and prepared food she offers her family is an atmo- 
sphere of good-fellowship and mirth, to which she 
should require every one at the table to contribute. 

Foods that are naturally easy to assimilate can be ren- 
dered indigestible as well as dangerous by careless hand- 
ling or wrong cooking. To be safe, food must be free 
from impurities, clean, and fresh. A freshly prepared 
warm meal is far more digestible than a cold lunch which 
may contain exactly the same materials. Even a single 
warm dish, such as a bowl of hot soup, goes far toward 
transforming a cold lunch. Mothers who habitually pro- 
vide "pick-up" lunches for the children because the fa- 
ther is away at noon make a great mistake. Children 
need as wholesome food as the father does. The value 
of warm lunches for school children has been well dem- 
onstrated by the Philadelphia experiment previously cited, 
and Philadelphia is only one of more than forty Ameri- 
can cities which are giving successful demonstrations in 
the proper feeding of school children. 

The three necessary qualities of digestible food — pu- 
rity, cleanliness, and freshness, and, we might add, 
savoriness — can be controlled in large measure, but 
not entirely, in the kitchen. In the cities children are 
often at the mercy of the dealers who supply their food. 
Mothers are not always sure of protecting their children 
against contaminated milk, stale eggs, embalmed meats, 
and various adulterations. It is necessary, therefore, 
for them to be alert as to the sources of the food they 
buy, and to exercise their influence for the correction 
of dangerous conditions in its preparation or handling. 

Dealers are sensitive to the complaints of their cus- 
tomers. The grocery store, for instance, that swarms 



230 HEALTH AND THE SCHOOL 

with disease-distributing flies, would be cleaned up in 
two days if the women customers made up their minds 
to require it. The dirty milkman would overhaul his 
shop if mothers insisted upon it. 

Providing the right food for children is evidently not 
altogether a household matter ; mothers, in order to have 
the right food in their own homes, must help get it right 
for the whole community. There is no more vital com- 
munity problem than this, and no more worthy field of 
work for women. 

B. Foods That Assist the Elimination of Waste. — A 
properly balanced diet must stimulate the bowels to re- 
move thoroughly all waste. While the diet cannot be 
held completely responsible for this important function, 
it plays a very important part in its performance. The 
daily diet should always contain some materials which 
assist the action of the liver and bowels. 

Fruits and green vegetables best serve this purpose 
and are accordingly indispensable for a healthy diges- 
tion. Certain fruits and vegetables have a more de- 
cided effect than others. Spinach and peaches, oranges 
and grapefruits, thoroughly cooked prunes and figs are 
all invaluable for preventing constipation. The seedy 
berries, such as blackberries and raspberries, are excep- 
tions to the general rule of the action of fruits. 

A great aid to thorough elimination is an abundance 
of pure drinking water. If the diet is too dry the 
processes of assimilation and elimination are greatly in- 
terfered with. It must be remembered that seven- 
eighths of the entire body is composed of water, that 
food to be assimilated must first be reduced to a liquid, 
that the skin and kidneys can eliminate poisons only 
when these are in liquid form. Plenty of water must 
be provided for these important functions. A good rule 



FOOD 231 

is to drink a glass of water (hot or cold, according to 
taste) the first thing in the morning and the last thing 
at night. Water at meals is most desirable, in spite of 
the popular and unfounded notion that it interferes with 
digestion. One matter, however, should be guarded 
against in drinking water at meals. It should not be 
taken to wash down unchewed food, but merely to sat- 
isfy thirst. A child between 8 and 12 years old needs 
at least 2 quarts of water a day. 

In following these general directions as to diet, moth- 
ers must remember that no rule, however good, works 
with every child. By careful observation they must find 
what forms of food seem especially adapted to their 
own children and what forms, if any, give rise to in- 
digestion. Normal children, however, may be expected 
to thrive if their diet is intelligently regulated by the 
general directions just given. Children who do not so 
thrive should have the advice of stomach specialists. 

Suggested Reading 

Bryant. School Feeding: Its Organization and Prac- 
tice at Home and Abroad. 

BuRNHAM. Food and Feeding of Children. 

The Cyclopedia of Education, Vol. II., pp. 627-630. 

Denison. Helping School Children, pp. 160-164. 

HoGAN. Children's Diet in Home and School. 

Home and School League, Philadelphia. Annual 
Reports of the School Lunch Committee, 1911 and 
1912. 

Hunt. The Daily Meals of School Children. U. S. Bu- 
reau of Education, Bulletin, 1909, No. 3. 

Kittredge. Report of the Nezv York School Lunch 
Committee, Journal of Home Economics, December, 
1912. 



232 HEALTH AND THE SCHOOL 

The Psychological Clinic, April 15, 1912. Sym- 
posium on School Feeding. 

WiTMER. The Special Class for Backward Children, 
Chapter VIL 



XIV 

CLOTHING 

Dr. Latta. — What clothes to wear? This question 
begins to press even before the baby is born, and con- 
tinues with unremitting insistence until it receives its 
final answer in the form of the shroud. Like the other 
fundamental requirements of civilized man, clothing 
should be regulated by a few important principles. 

The two watchwords for clothing children properly 
are comfort and cleanliness. If clothes are comfortable 
and reasonably clean they serve all the purposes of 
health. 

COMFORT 

Miss Parsons. — ^Absurd as it seems, I am puzzled 
to know when clothing is really comfortable. It can- 
not be that all the surprising demands of children's 
fashions are comfortable, and yet children endure them 
without complaint. My neighbor, for instance, who is 
very faithful in her observance of styles, puts a thick 
flannel suit on her nine-year-old boy in January, and 
on his seven-year-old sister a light lawn dress, low 
in neck and short in sleeve. Neither child appears 
to be uncomfortable, though it is true each one has 
catarrh. 

Dr. Latta. — It is quite possible that the catarrh is 
due to improper clothing in the case of both these chil- 

233 



234 HEALTH AND THE SCHOOL 

dren. The boy may be dressed too heavily and the girl 
too lightly, and both be suffering injury, though uncon- 
scious of it. It is not safe to leave the choice of suitable 
clothing to children, v^ho usually show great indifference 
in the matter. 

Mr. Martin. — What other guide is there to follow? 

Dr. Latta. — There are definite standards of comfort 
which parents can easily follow in selecting their chil- 
dren's clothing. Clothes to be comfortable (i) must 
not press upon the body or obstruct free muscular play ; 

(2) they must protect against exposure to cold and wet; 

(3) they must not be oppressive. These are universal 
rules, the application of which, however, varies greatly 
in individual cases. 

I. Clothing must not constrict. — No bands must be 
allowed to press ; if they leave markings on the body 
they are too tight. Garters must not exert a percep- 
tible pull ; no buttons or hooks should be hard to bring 
together; no shoes should press or twist or rub. Shoes 
should have broad, low heels and substantial soles, and 
be straight on the inside line; they should fit the instep 
and heel snugly and leave the toes free. The growing 
child must have free circulation and unrestricted activity 
of muscle. Unless clothing allows fully for this, it does 
great harm. 

There are many devices for minimizing the pressure 
and strain of clothes. Socks in warm weather do away 
with garter strain; union suits and one-piece dresses 
lessen the number of waist-bands. Loose trousers for 
boys and jumper blouses and bloomers for little girls 
make the desired tree-climbing and fence-jumping easy 
possibilities. Devices should be studied that are suitable 
to the climate and that will free children from the bur- 
den and restraint of clothes. 



CLOTHING 235 

2. Clothes must protect against exposure to cold and 
wet. 

Mr. Martin. — That injunction, may I say, is not as 
simple as it sounds. How is one to know the weight 
of clothing necessary to protect against exposure to 
cold? My boy Henry, who dresses in light linen, is al- 
ways warm from head to foot, while Katherine, swathed 
in flannels, shivers by the fire. There seem to be no 
standards for linens and flannels, as there are for bands 
and garters. 

Dr. Latta. — There can be no fixed rules for the 
weight of clothing as long as every child is unique in 
the rate of his circulation, the number of his red cor- 
puscles, his amount of fat, the vigor of his exercise, and 
his natural resistance. Every child must be studied and 
dressed according to his individual needs, and he must 
wear enough clothing to prevent his being chilly or 
damp. If your Katherine seems to need more clothing 
than most other children do there is probably something 
wrong with her. Find out what it is, but give her the 
extra clothes till you correct the condition that has low- 
ered her resistance. 

Mr. Martin. — How do you determine whether a 
child is warmly enough dressed? 

Dr. Latta. — A very simple but effective test is to 
find out whether his hands and feet are warm. If these 
are cold the child either needs more clothes or an im- 
proved circulation. This point brings up a matter which 
needs emphasis for all children, however hardy. The 
extremities must always be kept warm and dry. Sound 
rubbers, and arctics in severe climates, are no less neces- 
sary than overcoats ; mittens and warm caps are as im- 
portant as undershirts. Few children can resist colds 
and sore throats when their feet and hands are wet or 



236 HEALTH AND THE SCHOOL 

chilled, or escape catarrhal troubles when piercing winds 
reach unprotected glands in their heads and necks. 

An indispensable aid in keeping children warmly 
enough dressed is the thermometer. Indeed, in our 
climate of marvelous changes the mother who presumes 
to decide what her children shall wear outdoors with- 
out consulting an outdoor thermometer puts herself 
quite at the mercy of the weather man. Living in a 
sheltered apartment or flat, she often sends the little 
ones off to school or out for their morning's play quite 
unconscious that the mercury has dropped 30 degrees 
in the night. A thermometer outdoors and indoors is 
necessary for anything but the most haphazard regula- 
tion of children's clothing. 

3. Clothes must not he oppressive. — If a healthy child 
perspires without exercising rather vigorously he is too 
warmly dressed. Children who in winter must live in 
overheated houses and schoolrooms should dress almost 
as lightly as in summer. Clothes that overheat children 
cause far more disaster than those that leave them ex- 
posed. A perspiring child, going into the cold, is robbed 
of his natural means of resistance. Evaporation is re- 
ducing his heat at a dangerous rate, and his relaxed skin 
cannot quickly contract and protect him. On the other 
hand, a lightly-clad child who is not sweating loses no 
heat through evaporation and has, moreover, an effective 
natural protection in the contraction of his skin and 
outer blood vessels which drives the blood inward, where 
it does not lose heat, as it does on the exposed surface. 
The bodily warmth is maintained and the child comes 
through a brief exposure safely. A valuable rule for 
saving children from the oppression of clothes is to 
dress them as lightly as possible without allowing them 
to be chilly. 




HITTING THE HEALTH TRAIL. 



These Eskimo suits enable even frail children to gain the vigor 
offered by a winter out of doors. 




A WINTER PRESCRIPTION. 



Equal parts of out-door work and play are proving highly success- 
ful with these St. Louis children. 



CLOTHING 237 

Mr. Martin. — Do you approve, then, of my Henry's 
going so thinly clad ? 

Dr. Latta. — Decidedly. There is no more active 
creature alive than a ten-year-old boy. Why should he 
want flannels in our warm houses? H he attended 
an outdoor school and his home were kept as cool as 
English houses, he would need warmer clothes, but un- 
der present conditions he does not. 

Now, just a word about flannels. Pure woolen un- 
derwear is desirable for very young or delicate children 
or in very cold climates. Hardy children in moderate 
winter climates, if their outer suits are woolen, are bet- 
ter off without it ; so are their mothers, to whom the 
problem of supplying expensive flannel undergarments 
and keeping them properly washed without shrinking is 
often a great burden. If moderately warm underwear 
is desired it can be found in the excellent cotton and 
linen substitutes for wool now on the market, or in gar- 
ments containing a small proportion of wool, for it is 
to be remembered that wool possesses no magic property 
of its own for "keeping out the cold." The secret of 
its efficacy is the natural roughness of its texture which 
contains multitudes of tiny air chambers. Any other 
fabric spun and woven as wool is, to the extent that it 
possesses similar air chambers, has the same protective 
value as wool. As yet, however, no substitute has quite 
reproduced the springy mesh of wool which continues to 
serve best when a maximum protection is required. For 
this reason all cold weather outergarments, which at 
best are somewhat burdensome, should be of roughly 
woven pure wool, thus relieving children of every ounce 
of superfluous weight. It is a good plan also to have 
a little high-grade woolen underwear in reserve for some 
unaccustomed exposure, or an occasional cold snap. 
17 



238 HEALTH AND THE SCHOOL 

Mrs, Ross. — Many of my friends would be horrified 
to make any such change in the weight of their chil- 
dren's underwear during the winter. Two changes a 
year, one in autumn and one in spring, is their rule. 

Dr. Latta. — And when their children take cold they 
lay it to the changing weather and not the unchanging 
clothes, do they not? 

Mrs. Ross. — To be sure. I did the same thing until 
it occurred to me to adapt my children's clothing to the 
weather. In this matter the thermometer, as you sug- 
gested, is a great help. One soon learns what weight 
of clothing best suits a child at a given temperature. 
The thermometer indicates reliably whether it is a day 
for the heavy or the light overcoat, the sweater, or the 
thinnest dress. All these articles are often needed within 
two days or even one. 

Miss Parsons. — Striking evidence of your words is 
given in the Chicago weather record for May, 191 1, 
which showed a range in temperature from 33 degrees 
to 94.2 degrees. The whole month was a mad mixture 
of frost and torturing heat and snow. One can imagine 
the difficulty the mothers had in keeping their chil- 
dren sufficiently and not oppressively dressed during 
these bewildering days, and their sorrow, too, at the 
toll of sickness and death that the erratic weather 
exacted. 

Dr. Latta. — The difficulties would have been under 
control and the sickness in many cases prevented if 
mothers had realized the value of following the vagaries 
of the weather with their thermometers. If a day dawns 
hot, even after a snowstorm, children should shed their 
warm clothes. If the next day is ushered in by frost, 
they should put them on again. There is no other safe 
way. 



CLOTHING 239 



CLEANLINESS 

I. Clothes must be reasonably clean. — Only reason- 
ably. Mud and stains on the outside, unless of long 
accumulation, do no damage to health. The state of the 
underclothes is a more important matter, for it is 
through them that poison may be absorbed back into 
the blood. 

Those shrewd Orientals, the progressive Japanese, 
know the sanitary necessity of clean underclothing. 
During the war with Russia, whenever a battle was im- 
minent, the order went forth for every soldier to bathe 
and put on fresh underclothing. Why? To guard 
against infections of wounds. Never in history did 
battle wounds show so small a proportion of infection. 
Losses from wounds in both armies, compared with 
losses in most prior wars, showed a reduction of about 
60 per cent., the number dying from wounds being but 
4.5 per cent, of the entire number wounded. 

Clothing worn next to the body should be of coarse, 
soft mesh, as this has the triple advantage of absorbing 
perspiration, giving plenty of air space, and being easily 
washed. It should never be worn long enough to ac- 
quire the odor of the poisons absorbed from the skin 
and the bodily discharges. Soiled stockings must be 
particularly guarded against, as leather shoes keep the 
feet in an almost constant state of perspiration. 

Miss Parsons. — Many mothers find it too hard and 
expensive a matter to keep a family of children supplied 
with the right amount of clean underclothes, and they 
frankly give up the struggle. Are there not ways of 
simplifying the problem which will help them? 

Dr. Latta. — In the tropics all the underclothes of 



240 HEALTH AND THE SCHOOL 

the family are washed every day as a matter of course 
and necessity. In our temperate land we are unfortu- 
nately bound by the tradition of "wash day." It is not 
always possible to get all the necessary washing- done on 
that dedicated day. A little simple washing on one or 
two other days of the week, by either the servant or 
mother or children, would strain no one and might make 
it much more possible for the anxious mother to square 
her practice of cleanliness with her ideals. 

Mrs. Ross. — The difficulty of keeping underclothing 
clean can be somewhat further simplified by the chil- 
dren themselves. They should always remove all their 
day garments at night, shake them out, and hang them 
to air. This clears the clothing from the particles of 
dead skin which are constantly rubbing off the body, 
and freshens them. Frequent baths also serve the 
double purpose of keeping children's underclothing, as 
well as themselves, fresh. 

Dr. Latta. — Those are capital suggestions. Now, 
just a word concerning the cleanliness of outer gar- 
ments. While the condition of the outer garments has 
not such an intimate bearing upon health, it is a great 
mistake not to have all children's clothes, except perhaps 
the hats and overcoats, of the kind that can profit by 
frequent immersions in the tub. When clothes are clean 
they are free from poisons and germs. 

Night Coverings. — The principles which govern the 
selection of day clothing apply with equal force to the 
night coverings. The same care must be exercised to 
have them comfortable and clean. As the day clothes 
must not constrict or press, so the bedding must not 
burden children. Soggy, heavy, cotton comforters are 
abominations too often found in otherwise well-ap- 
pointed nurseries. New cotton comforters covered with 



CLOTHING 241 

a light material serve a useful purpose as extra cover- 
ings in cold weather; for daily use, however, wool and 
down comforters and blankets kept carefully washed 
give the greatest protection with the least weight. 

Mr. Martin. — It seems a trivial matter to mention, 
but I have a dreadful time keeping my children covered 
at all at night, regardless of whether the covering is 
wool, cotton, or down. They appear to take most of 
their exercise in their sleep. 

Mrs. Ross. — I have found it an invaluable practice, 
until my children were six or seven years old, not only 
to tuck their coverings well in, but to secure them firmly 
on both sides with large safety pins. The arrangement 
is kickproof. 

Dr. Latta. — That is an excellent plan to substitute 
for the common custom of mothers, which is to martyr 
themselves by rising frequently in the night to see that 
the little ones are covered. This practice is a sad waste 
of maternal energy, as wide coverings, securely fastened, 
serve the purpose even better than the visits stolen from 
the mother's rest. 

Children require less bedding than grown people, and 
it is quite as important to see that a child is lightly 
enough covered as to heap on the bedding if he is cold. 
Consulting the thermometer to determine the right cov- 
ering for a given night relieves a mother of much mid- 
night care. 

To keep beds fresh and clean is most important. Fre- 
quent sunning and airing are necessary for mattresses 
and pillows. An indispensable protection for the mat- 
tress is an easily washed quilted pad laid under the 
lower sheet. Unless such a pad is used a mattress in- 
evitably acquires the stains and odors that lend a hor- 
ror to second-class hotels and boarding houses, as well 



242 HEALTH AND THE SCHOOL 

as to too many hospitable homes. A mattress pad, 
washed when necessary, keeps the mattress fresh indefi- 
nitely. 

May I repeat now, in closing, the two watchwords 
for clothing of all kinds — comfort and cleanliness. 

Suggested Reading. 

Oppenheim. Care of the Child in Health, Chapter VHL 
WooLMAN. Hints on Clothing. Teachers' College Bulle- 
tin, Technical Education, Series A, No. 4. 



XV 

PLAYGROUNDS 

"Happy hearts and happy faces, 
Happy play in grassy places — 
This is how, in ancient ages, 
Children grew to kings and sages." 

Mr. Young. — An ideal physical environment for our 
children ! Every son's mother wants it. How many get 
it? Dr. Latta has been pointing out some of the prac- 
tical steps necessary for securing the right conditions. 
He has shown us how to feed and clothe and air our 
children properly — new accomplishments for most of us. 

These provisions are all fundamental, but they do not 
end the program. H we stop with food, clothing, and 
air, shelter, of course, being assumed, we provide rather 
less for our children than we do for our valuable horses 
and dogs. Such creatures must have their daily consti- 
tutionals on the avenue. What about our children ? Dr. 
Latta will tell us what the recreational needs of children 
are. 

Dr. Latta. — Next to the demand for food, the one 
conscious crying want of childhood is for play — active, 
outdoor, happy play. All parents know this. The 
need is pressed upon them a score of times each day, 
but seldom does it meet the full response it should. Not 
that parents are indifferent. They are glad to grant 

243 



244 HEALTH AND THE SCHOOL 

their children the luxury of whatever outdoor play is 
compatible with the ordinary demands of the day, the 
weather, and the facilities at their disposal. 

If, instead of a luxury, parents recognized abundant 
outdoor play as the necessity it actually is, they would 
abandon their present attitude of mere acquiescence, and 
move heaven and earth to secure it for their children. 
They would make it their first consideration in planning 
their children's days, in selecting the site for their 
homes, and even in choosing their own professions. 

Mr. Martin. — While I know in a general way that 
outdoor exercise is important for children, I should be 
very glad if Dr. Latta would explain to us why it is 
so. Just what does active play do for children, and is 
it really more necessary for them than for grown peo- 
ple? 

Dr. Latta. — The cell change in children's growing 
bodies is very rapid. This not only calls for active as- 
similation of food, but also results in the formation of 
much waste which must be promptly eliminated from the 
tissues and blood and bowels by the excretory organs. 
The organs, both of assimilation and of elimination, can 
be held to their proper work only when the whole body 
is regularly given vigorous and agreeable exercise. 

Children find this necessary combination in outdoor 
play. Without it their circulation becomes sluggish and 
their muscles lose the tone necessary to carry on the 
vital processes. The results are likely to be anemia, 
malnutrition, and auto-intoxication. Children need more 
outdoor play than grown people do because their circu- 
lation, to be kept up to the higher rate necessary for 
their healthy growth, requires a greater amount of the 
stimulus that comes from agreeable muscular activity 
in fresh air. Don't misunderstand me to say, however, 



PLAYGROUNDS 245 

that children need outdoor play more than grown peo- 
ple do. They simply need more of it. 

Mr. Ross. — I notice that you emphasize the need of 
making exercise for children agreeable. Why so? 
Aren't we trying to sugar-coat juvenile existence too 
much? Isn't the wood pile, though less attractive than 
the baseball diamond, quite as effective an aid to cir- 
culation? 

Dr. Latta. — By no means. A boy can chop himself 
out of breath on the wood pile, to be sure ; he can also 
develop some stout muscle there. A certain amount of 
this labor will serve him well enough, but even a year 
of such work will never give him the rounded physical 
development that an active baseball season affords. In 
the stress of playing ball the whole boy is stimulated to 
keenest activity. Brain and nerves as well as muscles 
are all brought into powerful action by the joy and ex- 
citement of the game. It is only under the influence of 
joyful excitement that children discover their full physi- 
cal capacities. Joyless exercise won't answer. 

It is one thing to recognize the demand of children 
for play. It is another thing to meet it. The need for 
play space in our cities has become acute. The need 
for play supervision in both town and country is no less 
urgent. Individual parents cannot handle these prob- 
lems alone. They can only be solved by cooperative 
effort of some kind. 

In the cities parents meet their children's appeals for 
outdoor play with a sort of helpless despair. They can- 
not provide private playgrounds ; neither can they deny 
the appeals. They are all finally forced to the same ex- 
pedient — to turn their boys and girls into the common 
and usually sole repository for children, horses, motors, 
beggars, thieves, and dirt — the city street. 



246 HEALTH AND THE SCHOOL 

Here the children acquire muscle and lung capacity; 
also germs and vicious habits. The street exacts a 
heavy toll for the development it offers. Many children, 
to be sure, having no other place to play, would perish 
if they did not have the streets; but just as surely many 
children perish because they do play there. 

Mr. Ross. — Now, before Dr. Latta's epigrams have 
us all converted to some new-fangled theories about 
children's play, let me ask a question or two. 

In the first place, is it necessary for the welfare of 
children to provide them with as much opportunity and 
space for play as they demand? If my boy, for instance, 
were free he would never do anything but play — except 
at meal-time; and, as for roaming, he would stray to 
the very edge of the world. 

Secondly, why isn't the city street a pretty good place 
to play in after all? If it answers for pedestrians, why 
not for playing children? The children don't object to 
it. My boy Edward, after a week's visit in a New York 
flat, came home to find his quiet, ample playground stale 
and unprofitable in comparison with the city pavements 
and the adventures they afforded. 

Thirdly, if parents disapprove of city conditions for 
their children, why don't they leave the cities? 

Dr. Latta. — Mr. Ross's protests have opened the en- 
tire playground question very satisfactorily. As it is 
one of those rare questions which has only one side, 
any approach, however hostile, leads to conviction. 

In answer to Mr. Ross's first question, I will say that 
it is necessary for the health of children to let them 
have all the outdoor play they naturally want, just as 
it is necessary to give them all the food they naturally 
want. Their health is dependent on these instincts, 
which in both cases we have seen to be vital ones. 



PLAYGROUNDS 247 

As for your boy, who you believe would do nothing 
but play if he were left free, may I ask whether you 
have ever tried the experiment? Normal children are 
fully as eager to work as to play, if they can find any- 
thing interesting to work on. When right occupa- 
tions are provided for children, the number of their 
play hours can safely be left to their own natural 
desires. 

Your boy's roaming propensities, too, are altogether 
wholesome. His feet are made to cover miles of earth. 
The best use he can make of a fence is to climb it. 
Let him roam by all means, but see that he does it in 
good company. Miss Parsons will give us some sug- 
gestions in this connection a little later. 

"Why isn't the street a pretty good place for children 
after all?" Now and then a city street is. A few care- 
fully selected, slightly traversed streets may be found in 
any city where the children can have wholesome, fairly 
safe fun. There are, in fact, in New York, Baltimore, 
and a few other cities little organizations called "Guilds 
of Play" which are devoted to promoting street play 
under competent leaders. These agencies are doing good 
pioneer work in demonstrating the desirable possibilities 
of street play. 

The experience of Mr. Ross's son on the New York 
pavements shows the fullness of life that can be reached 
in these surroundings — dusty, dirty, and dangerous as 
they are. We certainly do not want to eliminate the 
children from all the city streets, but we do want to 
eliminate the dust and dirt and danger, social as well 
as physical, that at present confronts them there. 

Even under the best regulations, however, the streets 
will never fill adequately the children's need for play 
space. Further provision must be made if the children 



248 HEALTH AND THE SCHOOL 

are to prosper in the cities. This brings us to Mr. 
Ross's third question — a most interesting" one. 

"If parents disapprove of city conditions for their 
children why don't they leave the city?" Most parents 
who can are doing exactly this. If those who can't 
could, the cities would be practically emptied. Or, if 
the people who wanted to live in cities stopped having 
children, what would the census look like in a genera- 
tion? 

Unless our cities desire to lead off in a race suicide 
crusade, they will not only have to stop making it a 
punishment to produce and rear children within their 
precincts, but they will have to offer all sorts of whole- 
some attractions that will invite the children to come 
and stay. Our most progressive cities are already alive 
to this need. We shall ask Miss Parsons to tell us of 
some of the steps they are taking to meet it. 

Miss Parsons. — First let me say just a word as to 
the significance of the playground and recreation move- 
ment which is now thoroughly launched in this country. 
Dr. Latta's emphasis on the need of play for children 
is in line with a great new idea which is stirring our 
country, and which is destined to have a powerful effect 
not only on the health but on the character and lives 
of our whole American people. Within the last six 
years it has been dawning on the national consciousness 
that the business of life is threefold — -to work, to love, 
and to play; that the emphasis on these three great 
functions should be fairly equal ; and, further, that a 
scheme of life which doesn't make ample provision for 
all three necessities — labor, human affection, and recrea- 
tion- — is bound to turn out warped and unhealthy crea- 
tures. This is just what has been happening for many 
years throughout our whole country. 



PLAYGROUNDS 249 

Our laws and ordinances have always recognized the 
first two requirements of living — the need to labor and 
the need to love. The law allows no children over six 
to escape the call to work. Each boy and girl must 
give eight years to the long school grind. The law also 
recognizes the human need for love by protecting, as 
well as its clumsy ways allow, the source of all affection 
— the family. 

How do our laws provide for recreation? They al- 
low for a few holidays and impose a few Sunday re- 
strictions, some of which greatly lessen the recreational 
possibilities of that day. With these few perfunctory 
provisions our cities and states until very lately have 
dismissed the subject of recreation. 

Mr. Ross. — Surely that is not quite all they have 
done. Do not most of our cities, in addition to recog- 
nizing holidays, provide their citizens with parks and 
breathing places? 

Miss Parsons. — To be sure. But, beyond pleasing 
the citizens' eyes and refreshing their lungs, what pur- 
pose do these parks serve? Is our one little park in 
front of the City Hall in any sense a recreation ground? 
For fifty years it has stood there, a mockery to child- 
hood, with its careful fences, "Keep Off" signs, and vigi- 
lant policemen ready to shoo away the children who ven- 
ture on the smooth walks with their roller skates. 

Mr. Ross. — Our town is not distinguished from other 
cities in that respect. 

Miss Parsons. — It has not been until recently. Our 
cities have generally been laid out with practically no 
provision for children's play. This is small wonder, for 
until very recent years almost no one beyond Froebel 
and his little stream of disciples has given a serious 
thought to this central need of childhood. 



250 HEALTH AND THE SCHOOL 

But the revolution has come. When the full mean- 
ing of the recreation movement once penetrates our 
town the children will have no difficulty in coming into 
their own. I predict that within three months our City 
Hall park will be given over largely to the children, and 
that before the movement loses headway with us we 
shall have municipal playgrounds, recreation centers, re- 
creation streets, gymnasiums, and baths — and these in 
sufficient numbers to give every child of our town all 
the wholesome play and recreation that he needs. 

Mr. Ross. — You will never get taxpayers to carry 
out so enormously expensive a program. 

Miss Parsons. — On the contrary, self-protection will 
compel them to do it, just as soon as they see that it 
costs less to support this program than the sickness and 
crime it will prevent. 

Mr. Ross. — But does it? 

Miss Parsons. — There is much reason to believe so. 
It costs $i.oo to keep a child in a playground six weeks. 
It costs from $18.00 to $40.00 to keep a child in a reform 
school the same length of time ; and from $40.00 to 
$60.00 in a hospital. A very few children saved from 
reformatories and hospitals would mean a sufficient 
money saving to support a populous playground. The 
juvenile court records already show an amazing decrease 
in boyish crime in the neighborhoods where playgrounds 
have been established. Since playgrounds were opened 
in the stock yards district in Chicago five years ago, 
juvenile crime has been reduced on an average of 44 
per cent, for the whole district — and what is still more 
striking — it has been reduced 70 per cent, in the imme- 
diate vicinity of the playgrounds, while only 28 per cent, 
in the regions farthest from them. In Cincinnati two 
years and a half of playground regime, between 1906 and 



PLAYGROUNDS 251 

1909, reduced the number of delinquent children brought 
before the juvenile court about one-third. 

Playgrounds have been improving health as well as 
morals. In Holyoke, Mass., the school medical inspec- 
tors have found a remarkable falling off in eye and skin 
diseases among the children v\^ho have had a summer of 
outdoor play. In Rochester the playgrounds have actu- 
ally saved a number of lives by providing safe recrea- 
tion. Before the playgrounds were established, there 
were annually 15 to 20 deaths from accidental drowning 
in that city. The year the playgrounds were opened the 
number fell to 3. 

Mr. Ross. — I should like to ask Miss Parsons whether 
any cities have yet launched such a wholesale benevolent 
scheme for recreation as she proposed for our town? 

Miss Parsons. — Many cities are to-day working 
toward such a program. A few are already beginning 
to carry it out. Chicago leads the world by having the 
finest system of combined playgrounds and recreation 
centers to be found. That city is not afraid to spend 
money for play. Her expenditures in the decade from 
1900-1910 amounted to $11,000,000. In Sherman Park 
alone the recreation buildings cost over $160,000. New 
York City has appropriated $16,000,000 for promoting 
recreation. 

Other cities have been hardly less liberal. Cincinnati 
in 1910 authorized a $1,000,000 bond issue for parks 
and playgrounds; Oakland, California, a city of 150.000, 
appropriated $430,000 for school playgrounds and their 
improvement; Grand Rapids, a city of 112,000, issued 
bonds for $200,000 for parks and playgrounds. In 191 1 
nineteen cities authorized bond issues for recreation pur- 
poses to the amount of $4,445,500. Of the 294 cities 
maintaining supervised playgrounds in 1912, 99 depended 



252 HEALTH AND THE SCHOOL 

entirely upon municipal support. The others received 
support from a variety of sources, municipal, county, 
state, and private funds. The drift is strong- and rapid 
in the, direction of public support. The number of cities 
establishing municipal playgrounds is increasing every 
month. 

It is only the most unenlightened communities that 
are not falling into line. That keen-scented individual, 
the ward politician, has. already discovered the popular 
appeal of the playground, and is now supplementing 
his time-honored method of bidding for favor with coal 
and turkeys, by securing recreation grounds for his 
neighborhood. 

Mr. Martin. — Our city evidently can not afford to 
lag behind in a movement that promises health and 
happiness to our children. We must have playgrounds, 
too. 

Mr. Ross. — That is a rather startling proposition tO' 
be made so lightly. There are many things to consider 
before we shall be justified in calling on the public treas- 
ury for the amount necessary to establish playgrounds 
in our town. Among other things we must ask what 
department of the town government would best have 
them in charge; how many, where, and what kind of 
playgrounds we need. This subject is so new and un- 
tried for us that I, for one, should hesitate to make any 
important decision regarding it without at least a year's 
consideration and study. 

Miss Parsons. — Your attitude seems to me exactly 
right, Mr. Ross. We should surely be making a calami- 
tous mistake to rush into a playground program with- 
out the most expert advice to guide us. There have 
been, indeed, in certain cities distressing instances of 
the misuse of playgrounds, which have been impulsively 




THE ETERNAL SPIRIT OF PLAY. 



Even the most cramped quarters of a crowded city playground can- 
not extinguish the instinct for play in normal children, but they 
make it difficult for any but the biggest and most boisterous 
ones to have a chance. 




THE MOST EFFECTIVE ARGUMENT FOR PLAYGROUNDS. 

The 1,200 children in the picture had no playground. This picture 
was effectively used by Detroit Saturday Ni"ht in a campaign 
which resulted in an appropriation of $65,000 for a playground 
adjoining this school. 



PLAYGROUNDS 253 

established without any provision being made for their 
careful supervision. Fortunately we need make no such 
experimental mistakes, for the methods of promoting, 
selecting, establishing, and supervising playgrounds have 
already been standardized. 

The Playground and Recreation Association of Amer- 
ica is bringing to a focus the best experience of the 
whole country in recreation work. More than that, 
through its conferences and conventions, its publication. 
The Playground, and its field secretaries, it is making 
this experience available to any community, urban or 
rural, that seeks its aid. 

If we desire to establish playgrounds in our town 
the association can help us at every step. A field sec- 
retary can guide us first in a "Recreation Revival," 
which will probably be necessary to awaken public sen- 
timent. During such a revival, which may occupy a 
week, every agency in the town that can possibly help 
should be pressed into service. Schools and churches, 
city departments, women's clubs, and private organiza- 
tions of all kinds should aid in advancing the playground 
idea. Such concentrated efiforts, though lasting but a 
week, have already accomplished in various towns far 
greater results than months and even years of scatter- 
ing effort have done. 

After the playground idea has gripped the town and 
a Recreation Commission been appointed — at present 
the best form of management for recreational affairs — 
we shall need expert aid in our next step, a "Recreation 
Survey" of the town. This survey will disclose exactly 
what our recreational needs and facilities are. As this 
highly successful form of calling attention to a public 
need is rather novel, I think you will be interested to 
run over a description of a recreation survey recently 
18 



254 HEALTH AND THE SCHOOL 

made in Milwaukee. You will see that it calls for a very 
accurate as well as graphic presentation of the vital 
facts concerning the question of children's recreation in 
that community. 

DESCRIPTION OF RECREATION SURVEY EXHIBIT 

Prepared by Rowland Haynes, under the Child Welfare Com- 
mission, for the City Budget Exhibit at Milwaukee, Wisconsin, 
November, 191 1. 

1. Three poster charts showing what 1,421 Milwaukee children 
seen out-of-doors were doing: 

18% working, 32% playing, and 50% doing nothing. 

2. Map showing 20 blocks in Milwaukee where 1,058 children 
between 4 and 15 years of age live, with open spaces free for 
play, and land built upon or cut up into too small lots for play. 

These lots and open spaces are shown in colors, and the chil- 
dren are represented by pins stuck into the streets and open 
places. 

3. Chart showing a second Milwaukee neighborhood with rela- 
tive amounts of open and occupied space, and traffic conditions 
of streets. 

4. Map showing third Milwaukee neighborhood of 20 city 
blocks, with schoolyard within its limits and park playground ad- 
jacent, also several vacant lots. 

The fact is shown that on a given Saturday morning, when 
459 children were out-of-doors in that neighborhood, none were 
in the schoolyard, none were in the park playground, 38 were on 
vacant lots, 55 in private yards, and ^66 on the streets. 

Caption used : "Play Leadership Needed to Use Spaces We 
Have." 

5. Charts showing density per acre in different wards of the 
city. Percentage of children to total population in the different 
wards. 

Every 57 minutes, day and night, winter and summer, a Mil- 
waukee child reaches the age of 5 and wants a place to play; 
every 72 minutes a Milwaukee boy or girl reaches the age of 16 
and wants a good time. 

Caption used : "Fight Vice with Wholesome Recreation." 

6. Charts showing numbers, distribution, and capacity of mov- 



PLAYGROUNDS 255 

ing picture shows and theaters, numbers of pool tables, billiard 
tables, and bowling alleys, with estimate given of where young 
people are on Saturday nights. 

7. Chart showing that Milwaukee has giown six times as fast 
as rural Wisconsin in the decade, 1900 to 1910. 

An idea of the form and arrangement most effective 
for such an exhibit as this of the Milwaukee Survey can 
be gained from the picture of the Philadelphia Baby 
Saving Show. (Page 198.) 

When the survey is accomplished we shall need the 
association's advice in the selection of a permanent rec- 
reation or playground director, who has been trained 
for this work. The technical knowledge of such a man 
is indispensable in determining how best to meet the 
needs the recreation survey has disclosed. His technical 
knowledge is fully as necessary for the selection, prep- 
aration, and equipment of the playgrounds as for the 
subsequent promotion of playground activities. 

Mr. Ross. — Miss Parsons has removed most of the 
difficulties which seemed to be in the way of launching 
our playgrounds, but I should like to question whether 
we are not being urged into a great outlay for some- 
thing that will benefit only a section of our community 
— the poorer section. We shall not want to send our 
own children to these rough-and-tumble places, shall 
we? 

Miss Parsons. — Your boy Edward's experience with 
the street crowd in New York would indicate that the 
public playground is exactly where he would be best 
pleased to spend his time. 

Mr. Ross. — Very possibly, but that is not where I 
should be best pleased to have him. 

Dr. Latta. — Should not the boy's own advantage 
settle the matter? What charm has any playground or 



256 HEALTH AND THE SCHOOL 

the most fascinating apparatus in the world if there 
isn't a crowd of children to use it? Our sheltered, 
well-to-do children need the expanding influence of the 
public playground as much as our poor children do. 
The little starched paraders on the avenues have less 
fun, on the whole, than the freer children of the poorer 
streets. The rich children need the democratic sliding- 
board and the friendly wading pool, too. These necessi- 
ties of childhood, under proper restrictions, should be 
set at convenient intervals all over the town. 

Mrs. Ross. — I should be most happy to have my 
children enjoying such public privileges if they were 
under wise and safe supervision. Now, as to Edward's 
special need, may I ask Miss Parsons what provision 
has been made for gratifying what Dr. Latta considers 
the healthy roving instincts of boys? 

Miss Parsons. — The Boy Scout organization, with 
its "hikes" and camps, provides very successfully for 
this instinct, as well as for many other perplexing in- 
stincts of boys between twelve and eighteen. Cross- 
country walking clubs are another means of supplying 
boys with distance to cover. The Chicago Playground 
Association has lately been carrying on interesting ex- 
periments with clubs of this sort. 

Mr. Martin. — What about the girls? They number 
four to one in my family. Do the playgrounds take 
them into special account, and has there been any or- 
ganization devised to serve them as the scout organiza- 
tion serves the boys? 

Miss Parsons. — You may well ask about the girls, 
for until lately their needs have been largely overlooked 
in favor of their more insistent brothers. In 191 1 a 
director of the New York Child Welfare Exhibit dis- 
covered that there was just twenty times as much or- 




ON THE TOBOGGAN TO HEALTH. 



These Vermont children find full scope for their love of action on 
an inexpensive home-made slide. 




BRINGING THE BEACH TO THE CITY. 

An inexpensive device which provides the refreshment and exhilar- 
ation of water play to hundreds of Philadelphia boys through 
hot weather. 



PLAYGROUNDS 257 

ganized effort being made for the recreation and de- 
velopment of boys as for girls. This discovery brought 
about prompt action on the part of recreation leaders. 
Experts began to study the possibilities of the play- 
ground for girls as w^ell as for boys, and soon intro- 
duced special games for girls over twelve. Most of 
these games are ball games of various kinds, requiring 
team work, a form of play which girls especially need, 
and they are proving highly successful. 

In addition to having playgrounds at their disposal, 
American girls now have open to them a national or- 
ganization for play and development which corresponds 
somewhat to the Boy Scouts. Leaders of the Play- 
ground and Recreation Association have launched an 
organization known as the Camp Fire Girls, which is 
admirably conceived to meet the needs and desires' of 
young girls of all conditions and climes. 

The organization is proving immensely popular and 
only waits for its rapid extension for competent women 
to take the leadership of the various clubs. In England 
the girls are being rapidly organized as "Girl Guides" 
with the assistance of Baden-Powell, the head of the 
Boy Scouts. These movements indicate clearly that the 
recreational needs of girls are being studied and met 
by those best qualified to handle them. 

Mr. Young. — Our time will not allow us to follow 
these interesting details any further, but our discussion 
has already brought out two things of prime importance 
— the needs of public and organized recreational facili- 
ties for our children, and a practical program for ob- 
taining them. 



258 HEALTH AND THE SCHOOL 

Suggested Reading 

American Academy of Political and Social Science. 

Public Recreation Facilities. 
Boy Scouts of America. Official Hand-book. 
Camp Fire Girls. Manual. 
Green. Among School Gardens. 
GuLiCK. The Healthful Art of Dancing. 

Camp Fire Girls. Manual. 
Playground and Recreation Association of America. 

The Playground (a monthly magazine). 
ScuDDER. Recreation for Rural Communities. 
Russell Sage Foundation. (Pamphlets.) 

The Exploitation of Pleasure. 

Recreation Legislation. 

The Unused Recreational Resources of the Average 

Community. 
United States Bureau of Education. The Reor- 
ganized School Playground. 



XVI 

HEALTH HABITS 

Mr. Young. — If a child were a plant or a jellyfish, 
dependent for his welfare merely upon wind, wave, and 
weather, a right environment would be complete as- 
surance of his health. 

Our children are not jellyfish. They are startlingly 
free agents who react very vigorously to their surround- 
ings, and if they react in the wrong way, they upset our 
best endeavors. A wholesome environment is an indis- 
pensable condition for children's health, but it is only a 
passive condition, and cannot possibly result in healthy 
children unless it is reinforced by the active cooperation 
of the children themselves. Their health still waits upon 
the final condition — their own habits. Dr. Latta will tell 
us what these habits should be. 

Dr. Latta. — A youth's habits are the crowning test 
of his education. The organization of a child's whole 
mature life and character depends upon what habits of 
thought and action have been set in his early years. No 
higher responsibility and privilege ever come to parents 
and teachers than to lead children to form their habits 
right. 

Mr. Ross. — You are, of course, referring to much 
more than mere health habits. It would be hard to 
see the connection, for instance, between the hygienic 
habit of brushing teeth and a great and good life. 

259 



26o HEALTH AND THE SCHOOL 

Dr. Latta. — The connection isn't so remote. More 
than one great and good life has been wrecked by evil- 
smelHng teeth and dyspepsia. In emphasizing the over- 
whelming importance of habit I am, it is true, referring 
to all the habits of thought and emotion and conduct 
which make up personality. The health habits are bound 
up with all these and cannot be completely disentangled 
from them. 

A man's habit of cleanliness, a mere physical habit, 
if you will, has much to do with the spiritual impres- 
sion he makes; and, again, a man's habitual outlook 
on life, a mere spiritual phenomenon, you may say, has 
a powerful effect on the efficiency of his stomach. There 
is no habit which does not exert a shaping influence upon 
both mind and body. 

There are, however, a group of habits whose first ob- 
ject is the promotion of personal health and strength. 
These concern the daily routine of the bodily machine, 
whose efficiency, as in the case of any machine, depends 
on proper use and care. 

HEALTHFUL BODILY HABITS 

The bodily habits have to do with breathing, eating, 
elimination of waste, exercise, bodily carriage, cleanli- 
ness, and rest. The rules which should govern these 
processes are simple and few, and can be both well com- 
prehended and practiced by fairly young children. 

BREATHING 

Respiration is the most urgent of all the bodily proc- 
esses. As the suspension of this vital process, even 
for a short time, causes death, nature has arranged for 



HEALTH HABITS 261 

respiration to be automatically carried on by the lower 
nervous system, without the aid of conscious effort. 
Through another set of nerve connections respiration 
can also be converted into a conscious act, which makes 
it possible to regulate the habits of breathing. These 
habits are of immense importance. They are indicated 
in the following brief rules : 

Breathe through the nose. — The importance of the 
form of breathing has already been discussed. If a me- 
chanical obstruction prevents nasal breathing, the con- 
dition should be corrected. If mouth breathing is a 
mere habit, it should be broken up. 

Mr. Martin. — How can it be broken up? 

Dr. Latta. — By enlisting children's efforts in their 
waking hours and giving them mechanical help, if nec- 
essary, during their sleep. If children's noses are un- 
obstructed it is quite safe to have their mouths held 
closed at night by means of an elastic support passed 
under the chin and over the head. 

Mrs. Ross. — I found an even simpler device which 
proved highly successful in overcoming the mouth- 
breathing habit in our boy. His upper jaw was becom- 
ing much distorted from his habit of leaving his mouth 
open. Our dentist assured me that it would do little 
good to straighten his jaw if the boy did not restore nor- 
mal pressure to his mouth by keeping his lips closed. 
The dentist suggested that I paste a paper label across 
Edward's lips after putting him to bed. This I did, tak- 
ing care that the label should stick only to the skin above 
and below the lips so as not to irritate the sensitive skin 
of the lips. While this little device was in no sense a 
gag, it did act most effectively as a constant reminder to 
the lips that their business was to stay closed. Edward 
has now completely overcome the need of the label. 



262 HEALTH AND THE SCHOOL 

Breathe with the diaphragm. — This method of inhal- 
ing, besides securing full breaths, exerts a tonic influ- 
ence on all the abdominal organs, their circulation be- 
ing constantly stimulated by the rhythmical pressure 
of the contracting diaphragm. Sluggish livers and 
stomachs are often connected with sluggish breathing, 
and can be corrected by correcting the breathing habits. 

Mr. Martin. — How is one to make sure that chil- 
dren are using their diaphragms when breathing? 

Dr. Latta. — When the diaphragm is used the abdo- 
men is visibly forced outward a little at every breath. 
Otherwise the upper chest alone is visibly extended. A 
certain amount of chest breathing is desirable, but it 
should never become habitual as a substitute for deeper 
breathing. To make diaphragm breathing easy, parents 
must provide bands and waists loose enough to permit 
full waist expansion. 

Take a fezv breaths as full and deep as possible in 
the fresh air every day. — The best time to do this is on 
first going outdoors. The lungs at these times seem 
actually to taste the fresh air, and are stimulated by it 
to expand their capacity decidedly beyond their stale 
air limit. 

This little practice of taking a few deep fresh breaths 
every day has a remarkable effect in keeping up the vi- 
tality and the resisting power of children. It is also 
of distinct service in certain emergencies, such as the 
beginning of a cold. It is often possible to check a cold 
in the incipient stages of chills and sneezes by breathing 
in the way described at the moment the approaching 
symptoms are felt. In fact, whenever a little extra 
strength or courage or energy are required, a few deep 
breaths of fresh air will usually provide the necessary 
power. 



HEALTH HABITS 263 

Breathe fresh air "whenever possible. — The vital im- 
portance of fresh air we have already explained. It is 
equally important that children be trained to enjoy and 
demand it. A taste for fresh air is easily acquired and 
is a life-long safeguard against disease. The way to 
make children love fresh air is to give them plenty 
of it. 

EATING 

Selecting food wisely for children is one thing, and 
an important thing. Eating it is another thing, and 
fully as important. In the latter operation the children 
play the leading parts. In justice to a well-selected diet 
they must be taught to play their parts well, observing 
faithfully the following rules : 

Che-cv food thoroughly. — Everybody knows the im- 
portance of this rule. How many people practice it? 
Fletcherism has become a household word, but by no 
means yet a household practice. 

Mr. Ross. — And why should it ever become one? 
The human race enjoyed its meals in its own way scores 
of centuries before Horace Fletcher learned to chew. 
What right or reason has one man to try to upset the 
racial instinct to bolt food? 

Dr. Latta. — You can't pin your faith to racial in- 
stincts when science pronounces them wrong, Mr. Ross. 
Our ancestors had their own reasons for gobbling. We 
have none. On the contrary, we pay a heavy price for 
perpetuating the table manners of the troglodites. 

Mr. Ross. — Why is it so important to chew food? 
As I remember my physiology, there are quantities of 
contrivances below the mouth that are designed for 
nothing but the manipulation of foods. 



264 HEALTH AND THE SCHOOL 

Dr. Latta. — None of them is fitted with teeth, how- 
ever. Mechanically considered, they are merely a mass 
of self-contracting elastic tubes. What sort of job can 
they make of stuff that needs to be chopped and ground ? 

Not only is the mouth most important as a food mill, 
but as a food converter. The starches are all digested 
in the mouth — or ought to be — by being ground up with 
the saliva. Starch indigestion, a favorite ailment of the 
day, does not occur among faithful chewers of food. 

Eat regularly at proper intervals. — Next to thorough 
mastication this is the most important rule to observe 
in eating. The stomach becomes accustomed to a regu- 
lar routine, and is more ready to work at the usual hour 
than at irregular times. Enough time must always be 
allowed between meals for the stomach to carry on its 
work of digestion, which in some cases requires four 
hours. Having but one compartment, it cannot properly 
handle a half-digested meal and a freshly eaten lunch 
at the same time. It should, moreover, have a chance to 
rest before a new task is placed upon it. 

Mr. Martin. — Doesn't the mid-morning school lunch 
interfere with this observance? 

Dr. Latta. — Not necessarily. H a light lunch fol- 
lows three hours after a light breakfast, and is in turn 
followed by a dinner at least two or three hours later, 
the stomach can handle it very comfortably. One lunch 
a day, however, in addition to the three regular meals 
should constitute the limit of indulgence for children. 
Candy between meals is, of course, taboo. 

Avoid harmful foods. — Children should be made to 
understand what constitutes a suitable diet and to ob- 
serve its restrictions as a matter of course. In addi- 
tion to the usual articles of food and drink which chil- 
dren should avoid, such as tea, coffee, fried foods, and 



HEALTH HABITS 265 

pastry, there are certain foods, wholesome enough for 
some people, but actually poisonous to others. Straw- 
berries, shellfish, even milk, act as poisons to certain 
constitutions. Children who happen to show such an 
idiosyncrasy, known as allergy, should be taught to rec- 
ognize them and to make a habit of quietly avoiding the 
troublesome articles of food. 

Use care in drinking zvater. — Children must be trained 
to avoid drinking water which comes from doubtful 
sources, such as attractive roadside brooks and enticing 
old wells. Danger lurks in any but certified sources of 
drinking water, and a little temporary thirst is a small 
price to pay for security from infection. 

Another precaution very necessary to impress upon 
children is not to drink cold water when heated with 
exercise, unless the exercise is to continue for some time 
after the drink is taken. Everyone who has had any 
experience with horses knows the importance of this 
rule. The precaution is not usually so faithfully ob- 
served in the case of children, but the need for it is 
exactly the same. In this connection we should mention 
the paralyzing effect of ice water, which may well be 
called our national drink. The ice water habit is an 
acquired one, which children can easily be kept from 
contracting. 

Mr. Martin. — Should children be allowed to drink 
water at all at meal time? 

Dr. Latta. — They should. Modern experiments have 
shown that it is highly desirable to drink water in 
small sips while eating. The water should not, of 
course, be at a freezing temperature nor excessive in 
amount. One glass at a meal is a good allowance. The 
harm in drinking water at meals comes when it is swal- 
lowed in large amounts to wash down unchewed food. 



266 HEALTH AND THE SCHOOL 

Eat only when hungry. — This does not mean that 
children should eat whenever they think they are hun- 
gry. Some profess to be in that condition all the time. 
When their normal appetites fail, however, it is a mis- 
take to force them to eat. A diminished appetite in- 
dicates that the stomach's power of digestion is tem- 
porarily diminished. Rest may restore the power. 
Food that must be digested will only weaken it further. 

There are certain conditions that depress the stomach 
powerfully, and with it the appetite. Unusual fatigue, 
pain, and great emotional excitement — notably anger and 
fear, are ruinous to digestion. The meal should wait 
till the unwholesome state of mind or body has been 
improved. 

Mr. Martin. — Would you allow children's appetites 
to dictate their choice of foods at all? 

Dr. Latta. — This is advisable, provided they do not 
quarrel with the staples of their diet, their milk, ce- 
reals, and fruit. When they begin to crave abnormal 
things, like sour pickles, and chalk, and show an aversion 
to their proper fare, they need the advice of a stomach 
specialist or possibly some old-fashioned disciplinarian. 

Drink abundant water. — This habit, if fixed in child- 
hood, is a powerful defense against those arch enemies 
of civilized man, constipation, auto-intoxication, and kid- 
ney disease. The poisons which are constantly forming 
in the body and which should be eliminated by the kid- 
neys and the skin can be discharged only if there is an 
abundance of water to dissolve them. 

We usually understand by bodily cleanliness the con- 
dition of the skin. This is highly important, but rather 
less so than the internal cleanliness of the body. This 
can be maintained only by drinking plenty of pure water 
every day. It is an excellent habit to begin the day 



HEALTH HABITS 267 

with a glass of water, hot or cold, according to weather, 
vitality, and inclination. It is also a good plan to have 
other regular times for drinking water during the day. 
The habit soon becomes automatic. 

Mr, Martin. — What do you call an abundance of 
water ? 

Dr. Latta. — From a quart and a half to three quarts 
a day, according to the climate and the age and activity 
of the children. 

Make every meal a feast of mirth. — This obligation 
rests on every food consumer. Good cheer makes even 
impossible food digestible. Heated arguments, cares, 
anxieties, and reproofs are as deadly table companions 
as flies. The intelligent household does not tolerate 
them. 

No item in a child's whole education is more impor- 
tant than the art of cheerful dining. 

ELIMINATION OF WASTE 

The body would be destroyed in a few hours by its 
own poisons if these were not being constantly elim- 
inated. The lungs, the skin, and the kidneys are dis- 
charging poisons from the system all the time. The 
lower bowels also are constantly gathering the poison- 
ous waste discarded in the process of digestion. The 
frequent and regular discharge of this waste is an in- 
dispensable condition to health. 

Keep the bowels active. — The necessity of a daily ac- 
tion of the bowels is generally recognized by mothers 
of young babies, but is not so often borne in mind after 
children have become able to care for themselves. Par- 
ents should not relax their vigilance until the habit is 
thoroughly fixed, and the children are trained to report 



268 HEALTH AND THE SCHOOL 

any failure of the daily action. If such failure is ex- 
ceptional it can usually be corrected with a very slight 
enema. The use of the syringe should never become 
habitual, however. A chronic tendency to constipation 
cannot be altered by the use of either enema or drugs. 
Correct diet and proper exercise will conquer this diffi- 
culty with most children.* 

While, in distinction from the bowels, the skin, kid- 
neys, and lungs discharge their waste without conscious 
efifort, it should be made plain to children that this 
process is greatly aided by wholesome bodily habits, such 
as exercising vigorously, drinking plenty of water, bath- 
ing, and breathing fresh air. 

Keep the skin at tvork. One of the organs of elimina- 
tion, the skin, needs particular attention to offset the 
enervating effect of civilized life with its deadening 
clothing and shelter. Frequent bathing to keep the 
pores clean and open is, of course, necessary, but a more 
active program than this must be followed to make the 
skin really vigorous enough to pass off daily the pint or 
two of effete matter that it should. 

A very simple but effective tonic is a dash of cold 
water following a warm bath. This has an almost elec- 
trical effect on the skin, and in health it should be the 
invariable practice. 

A quick, cold sponge bath in the morning is also an 
excellent means of developing a vigorous skin. This 
practice is desirable for children, who react promptly 
from the cold of the water and whose skin is soon glow- 
ing with warmth. When a sense of chill follows the 
bath, however, and the bodily temperature is actually 
lowered, the effect is only damaging. Delicate chil- 
dren can often be brought up to a state vigorous enough 

* See suggestions on diet, page 230. 



HEALTH HABITS 269 

to profit by the cold sponge, but the process must be 
carried on with care and judgment. 

Another vitaHzing treatment for the skin is a thor- 
ough perspiration followed by a bath and rubdown. 
This process removes a quantity of poison from the 
body and sets all the surface nerves tingling with a 
new feeling of comfort and energy. This agreeable ex- 
perience should be granted to children several times 
a week. Before long our schools will provide 
the opportunity for it in playgrounds, gymnasiums, 
and swimming pools. In the meantime it must be 
made as easy as possible for children to have a cool bath 
and rubdown at home whenever they have perspired 
freely. 

A further means of keeping the skin alive and active 
is to let it enjoy a change of temperature now and then. 
Qiildren are not naturally hot-house flowers. Their 
skins, as were those of their aboriginal ancestors, are 
made to resist heat and cold. It is actually undesirable 
that all the rooms in the house be of the same tempera- 
ture and that children should always bundle up for a 
brief run in the cold. A short stay in a cooler temper- 
ature is always refreshing. It is in a long and gradual 
chilling that danger lies. 

Mr. Ross. — Will you tell me why you are impressing 
us with all these directions for exercising the skin ? We 
have our clothing and we have our furnaces, which our 
merely skin-protected ancestors did not have. We mod- 
erns could almost dispense with our skin. Why drag it 
out into such prominence? 

Dr. Latta. — Because the state of the skin very large- 
ly determines one's state of mind, one's comfort, energy, 
and hope, or one's weariness and despair. This is no 
exaggeration. By far the greatest number of the nerves 
19 



270 HEALTH AND THE SCHOOL 

of sense terminate in the skin. The sum total of their 
impressions has a tremendous effect on one's conscious- 
ness. If the skin is clean, healthy, and active, one's 
sense of existence is brightened by a thousand agreeable 
sensations. If the condition of the skin is bad the re- 
verse is true. 

No theory in health is more easy to demonstrate than 
this one, and no physical habit is more important to im- 
press upon children than the habit of keeping the skin 
at work. 

EXERCISE 

While the vital bodily processes, digestion, circulation, 
respiration, and elimination of waste, are all carried on 
involuntarily, the vigor with which they are performed 
depends entirely on the tone of the muscles. This in 
turn depends on the exercise which is given to the vol- 
untary muscles. 

Keep the muscles Urm and elastic. The stomach, the 
liver, the heart, and the other vital organs do not call 
for help in handling the details of their work, but they 
do make a daily demand for power to carry it on — the 
power that lies in firm, elastic muscles. To the extent 
that this power fails, the work of the vital organs fails. 
The only way to keep a good muscular tone is by regu- 
lar and sufficient exercise. When children are allowed 
to follow their own instincts, which is seldom, they take 
all the exercise they need. They rarely need formal 
exercise in addition to their active play. 

Mr. Martin. — I wonder whether they don't often 
take more exercise than is good for them. 

Dr. Latta. — Not unless they are stimulated to undue 
endeavor by the admiration or the taunts of their friends. 



HEALTH HABITS 271 

This, however, is one of the serious dangers of unsu- 
pervised play. It is not an unheard of thing for children 
to drop dead from trying to make records at jumping 
rope or to be badly injured by attempting other feats 
to which they are unequal. 

Four cautions of utmost importance should be im- 
pressed upon children in connection with their exercise: 
(a) never to run or play actively until at least half an 
hour after a hearty meal; (b) always to stop when they 
are out of breath or their hearts feel oppressed; (c) 
never to attempt feats that they really fear; (d) never 
to cool off suddenly when heated, except by means 
of a cold bath, which should be followed by vigorous 
rubbing. 

With these simple but imperative restrictions children 
should be encouraged to do all the running and jumping 
they want to, and to demand as their daily right three 
or four hours of active outdoor play. The weather, 
of course, often interferes with this ideal program. 
In that case the children should be provided with a 
sheltered space, either at school or at home, where 
they can be free to romp and roar as much as neces- 
sary. 

If children who are housed do not have the chance 
to play as actively as they would like to, they should be 
given a few hearty gymnastics every day. Vigorous 
body bendings, swimming strokes, and dancing steps 
serve to keep the vital functions active till the skies 
clear. 

The habit of exercise is the easiest of all habits for 
children to form. The only help they need is a good 
outdoor space and good leaders who can guide them in 
the most joyful and valuable pursuit of childhood — 
healthful, friendly play. 



272 HEALTH AND THE SCHOOL 



BODILY CARRIAGE 

No one disputes the wholesome effect of an erect pos- 
ture on both mind and body. The acquiring of a fine 
carriage is a matter on which enormous emphasis is laid 
in military schools — and in almost no other place. So 
desirable, however, is a straight and strong carriage con- 
sidered that parents frequently send their boys to mili- 
tary schools for no other reason than to have them de- 
velop a military bearing. This magical bearing could 
and should have been acquired in the nursery, without 
the aid of a highly paid, brass-buttoned officer. 

Mr. Martin. — But how? Apparently the process 
isn't so easy, for three of my children have passed out 
of the nursery without gaining a creditable carriage. 

Dr. Latta. — Either your children weren't well or 
some one blundered. If children are free from adenoids 
and eye strain and in reasonable health, straight backs 
are easy to come by; but the person in charge must un- 
derstand well the two simple requirements for cultivat- 
ing such backs. 

Mr. Martin. — What are these requirements? 

Dr. Latta. — To hold one's own spine straight, and 
not to allow the children's spines to slump. 

Mr. Martin. — That sounds delightfully easy. But 
what has one's own spine to do with the process? 

Dr. Latta. — Almost everything. Example is the 
most powerful force in the early education of children. 
If you want your children straight be straight yourself. 

Mr. Martin. — And when example fails, as I've seen 
it do, how is one to compel children to keep erect? 

Dr. Latta. — How do they compel the boys in the 
military school? By making the acquiring of a correct 



HEALTH HABITS 



273 



carriage the chief business in hand till the habit of a 
good position is thoroughly fixed. This process usually 
takes about six weeks. Most children are not too busy 
to afford that length of time for acquiring a permanent- 
ly fine carriage. Could six weeks be spent in any bet- 
ter way? 




ERECT CARRIAGE — A HABIT WORTH ACQUIRING. 

By a little persistent effort, bad posture can be corrected and an 
erect carriage acquired like any other good habit. 

Mr. Martin. — I've been ordering my children to 
stand straight for far longer than six weeks, but you 
ought to see them when they attempt to straighten up. 
They fold their shoulder blades across their backs, point 
their chins toward the sky, and hollow their backs so 
grotesquely that I am relieved to see them relapse into 



274 HEALTH AND THE SCHOOL 

their natural slouch, which they soon do. Can you tell 
me how to make them really straight? 

Dr. Latta. — If they will drop all their efforts with 
the smalls of their backs and their shoulder blades and 
chins, and observe the following simple directions, they 
can easily straighten up. 

Push the neck hack against the collar. Hold up the 
chest. Hold in the abdomen. Put the weight on the 
ball of the foot. Keep this position by day, and as com- 
pletely as possible by night. 

Six weeks of this regime will transform your crooked 
children. 

CLEANLINESS 

There are two kinds of cleanliness, aesthetic and hy- 
gienic. The former concerns itself with appearances 
and odors, the latter with actual conditions that deter- 
mine health. Neither of these brands appeals naturally 
to the young of the human species. Not till the mating 
instincts appear are parents able to relax their struggles 
with their spontaneously dirty children. Without stop- 
ping here to discuss the various hopeful means of coerc- 
ing children to keep decently clean, I wish to emphasize 
a few details of hygienic cleanliness which children are 
always eager to practice when the advantages are un- 
derstood. 

Keep the germs washed off. It does not impress little 
girls and boys much to be told that frequent bathing is 
a double safeguard to health, aiding both in the elim- 
ination of bodily poisons and the prevention of infection 
from outside. These important truths are too general 
to serve as strong motives. When children find, how- 
ever, that their little wounds, their cuts and scratches 
and scrapes, never become sore or fester if well scrubbed. 



HEALTH HABITS 275 

and that burning, itching- surfaces are soothed by cleans- 
ing, they develop an actual affection for soap and water. 
When they find that their sore throats and stuffy noses 
and uncomfortable eyes get well if kept clean, they 
themselves put in a strong demand for gargles, nasal 
douches, and eye washes. 

Mr. Ross. — You surely wouldn't make such clinical 
processes as these the daily operations of children? 

Dr. Latta. — Only when an irritated condition of the 
mucous membranes requires it. This happens often in 
our barbarously dusty cities. Dust and germs lodge in 
quantities on the mucous membranes of the eyes, nose, 
and throat, and should be invariably rinsed out with a 
mild antiseptic if they cause the least irritation. Ordi- 
nary inflammation of the nose, throat, and conjunctiva 
(the mucous membrane of the eye) can easily be checked 
by a thorough cleansing of the infected surfaces. 

The mouth and throat should be well rinsed out every 
day, the eyes whenever they show any irritation, and the 
nose whenever there has been exposure to infection from 
another's cold or whenever congestion, either chronic or 
acute, is present. In catarrh, nasal irrigation should 
take place twice daily till the condition is relieved. 

Mr. Martin. — I confess to some fear of nasal irriga- 
tion. I have heard that 

it is likely to set up ^ % ^^^ 
trouble in the Eusta- \^^ *^ '*|^^ C3___ 

chian tubes. ^\^ r::TT-=i=^=^=s::rT^>^ 

Dr. Latta. — So it is %^ ^ ■.■■■-'yMi 

if not done properly; \ .^^>:.y3h'>i-ivt'j3M'i^^^^^^^^^ 

that is, if liquids are nasal cup. 

inhaled or injected into^his allows a cleansing wash to flow 

the nose. This method through the nostrils without the 

... , , f strain or pressure caused by in- 

is very likely to force haling liquids. 



276 HEALTH AND THE SCHOOL 

some of the liquid into the Eustachian tubes and thus 
inflame them, but if the Hquid is allowed to flow gently 
into the nasal cavity from a glass cup designed for the 
purpose, the operation involves neither discomfort nor 
danger. This means of cleansing and disinfecting the 
nose has wrought a revolution in the control of nasal 
afifections, and has put many of the ineffective atomizers 
into the historic museums, where they belong. 

Mr. Martin. — What antiseptics should be used in 
these various washes? 

Dr. Latta. — For the nose, throat, and mouth a salt 
solution — one-half teaspoon to a glass of warm water — 
is effective and safe. Solutions of listerine, glycothymo- 
line, certain alkaline tablets, and other mild antiseptics 
are useful, but the brands and the 
strengths of solutions should have 
the endorsement of your physician. 
For a mouth wash alone a solution 
of 2 teaspoonfuls of cinnamon oil to 
a pint of water is excellent. 

For the eyes there is nothing better 
than a solution of boric acid — 2 tea- 
EYE WASH CUP. spooufuls to a pint of water. This 
The only way to solution should be kept ready in a 
cleanse eyes is to clean, covered bottle and applied with 
ougVTitW an eye cup or poured into the eye as 
wash. The shape the head reclines. The easiest way 
it to^brSiJertrd to rinse the eyes of little children is 
over the eye, thus to have them lie down, and then to 
insuring a com- . ,, , , • u 1 j 

plete rinsing. pour the solution over each closed 

eye separately. When the eye is 
opened it immediately becomes filled with the wash 
without the discomfort that is caused by pouring it into 
the open eye. Boric acid must not be regarded as a 




HEALTH HABITS 277 

medicine to apply gingerly in the form of drops. It is 
a cleansing wash that must be used liberally to be ef- 
fective. 

Before we dismiss the subject of washes we must con- 
sider the essential matter of clean teeth. These should 
be brushed thoroughly up and down — as well as side- 
ways — with tooth powder or paste at bedtime. They 
should be lightly brushed also after breakfast, and as 
many times more in the day — on rising and after other 
meals — as inclination and convenience dictate. If chil- 
dren show an unusual tendency to dental decay or to a 
deposit on the teeth, they should be required to brush 
their teeth thoroughly two or three times a day. The 
presence of organic deposits is sometimes only discov- 
ered by a stain on the teeth which follows the eating 
of berries or grapes. This deposit should be kept 
scrubbed off, and the disordered stomach which lies at 
the root of the trouble brought to a healthy state by a 
correction of the diet. 

Mrs. Ross. — Before the general topic of cleanliness 
is dismissed I should like to ask Dr. Latta just how 
much bathing children need to keep wholesomely clean. 
The complete daily bath is, of course, an ideal arrange- 
ment, but is far from easy to accomplish in large fam- 
ilies with limited facilities. 

Dr. Latta. — A partial bath at least should be given 
every day, either on rising or at bedtime. This should 
include, besides hand, face, and fingernails, ears, neck, 
armpits, crotch, and feet. Not less than once a week 
there should be a complete bath, including hair and scalp 
if possible, in warm water with plenty of soap, to be 
followed by a dash of cold water and a vigorous rub. 
In addition to the thorough weekly cleansing, the whole 
body should be bathed whenever it has perspired freely. 



278 HEALTH AND THE SCHOOL 

It should also be an invariable rule to cleanse imme- 
diately any part of the skin that has become abraded 
or cut, and to protect it from further infection by a 
simple antiseptic dressing. Boric acid powder scattered 
over the surface, which is then bound up in aseptic ab- 
sorbent cotton, is an easy and effective way to dress a 
simple wound. 

Do not collect or distribute disease germs. — Clean 
habits are no less important for the children who prac- 
tice them than for their associates. Particularly is this 
true of the habits that concern the spreading of disease 
germs. In addition to keeping well washed, children 
should observe strictly the following rules for prevent- 
ing infection to themselves and others : 

Never handle the organs of the body, as mucous mem- 
branes are easily irritated and infected; don't pick 
the nose, but always carry a handkerchief. Don't 
rub the eyes or any other organ. 

Never put anything in the mouth except food and drink 
or things intended for the mouth. 

Never exchange or lend candy, gum, whistles, or any- 
thing that is intended for the mouth. 

Never kiss upon the lips ; kiss the forehead or cheek. 

Never face another person when coughing or sneezing. 

Never spit where it will be possible for the feet 
or skirts of others to catch up the germs you have 
left. 

Never leave anything dirty or offensive exposed where 
it can be an annoyance or where it can be reached 
by flies. 

A clean body in clean surroundings holds disease at 
arm's length. 



HEALTH HABITS 279 



REST 

In our discussion of a school child's daily schedule we 
heard some good suggestions concerning rest, among 
them being the necessity of long hours of sleep for chil- 
dren and the need of a partial rest after hearty meals. 

In addition to arranging for such rest parents must 
see that the children actually get it. Many children, 
through poor nervous control or indigestion, have much 
difficulty in getting to sleep or in really resting when 
they need to during the day. This is a serious condition 
which, if continued, is bound to do permanent damage 
to the nervous system. Restless nights can often be 
corrected by simplifying children's suppers and avoiding 
any exciting or straining occupation during the hour 
before bedtime. 

Learn to relax. — Often, however, the failure to rest 
properly is merely a bad nervous habit and must be cor- 
rected through the cooperation of the child himself. 
Many of our children even at an early age need instruc- 
tion in the art of repose, the only defense against our 
constantly intensifying modern life. They must not be 
allowed to outgrow the power they had as babies of 
completely relaxing their brains, nerves, and muscles. 
Sleep cannot long resist such an invitation. 

A moment or two of such genuine relaxation during 
the day is often of great value, averting many stormy 
tantrums which are merely the automatic results of over- 
wrought nerves. I know one mother who, when she saw 
signs of an approaching fit of rage, as her little girl 
called the unhappy visitations, told the child that if she 
would sit very still and let herself feel heavy the fit 
would pass by without touching her. It did, and the 



28o HEALTH AND THE SCHOOL 

little girl was so pleased with her success that she forth- 
with adopted this method of relaxation for use in mo- 
ments of emotional temptation. 

Do not dawdle. — Some children unconsciously try to 
rest by dawdling half-heartedly over their occupations. 
This is a pernicious habit, bad both for nerves and char- 
acter. Children should either be engaged in hearty ac- 
tivities that interest them and are worth while or should 
be frankly resting. They should not be reproached for 
occasionally lying down or sitting in complete idleness. 
The vacant, contented look- they wear at such times 
means rest. It is their aimless movements and efforts 
that must be checked. Dawdling around is neither 
work, play, nor rest. It opens a sure approach to vicious 
habits of various kinds, and finds no place in a well- 
appointed life. 

Children who are able to direct their energies vigor- 
ously and effectively and know when and how to rest 
them have learned a fundamental lesson in self-control. 



HEALTHFUL HABITS OF MIND 

Cidtivate cheer, hope, joy, and fun. — Good health re- 
quires that the state of mind be under control as well 
as the state of body. Certain habits of thought and 
feeling should be persistently cultivated, others as per- 
sistently discouraged. A courageous, energetic habit of 
action, a cheerful, hopeful outlook, and a readiness to 
seize upon joy and fun, while not exhausting the list 
of moral virtues, are those that contribute directly to 
health and vitality. To help cultivate these tendencies 
in one's children is as important as providing them with 
food and baths. 



HEALTH HABITS 281 

Refuse to feci anger, fear, and zuorry. — Like poisons, 
to be shunned^ are those deadly conditions of mind — 
anger, fear, and worry. They play havoc with youthful 
nerves, and should be guarded against with all possible 
care. No precautions can, of course, keep them entirely 
away from children, but the troubled moments, when 
they do come, can be made to have truly educational 
value. 

If the anger, fear, or worry can be converted into 
desirable action, such as punching an offending ruffian, 
or leaping from before a rushing engine, or running for 
the doctor, it has served a useful end. It is the help- 
less bursts of anger and the unreasonable fears that 
must be firmly checked, and nothing is easier to do when 
the way is understood. If a child relaxes his muscles 
completely, or, better still, turns his attention to some- 
thing worth while, his anger flees from him ; if he takes 
a few deep full breaths his fear and worry depart. 

These little physical suggestions outclass, both in sim- 
plicity and effectiveness, long moral exhortations which 
have small place in a nursery. It is easier for a small 
boy to relax his muscles or get busy than to "be good." 

Mrs. Ross. — Are we, then, to cultivate our children's 
morals through their muscles? 

Dr. Latta. — That is certainly a sound method of ap- 
proach. Young children should be taught to use their 
muscles and their bodies morally. A healthy, well-occu- 
pied child is a good child. 

Mr. Martin. — One question more. In your discus- 
sion of habits you have said nothing about the vicious 
habits that we are always being warned to guard our 
children against. 

Dr. Latta. — They would hardly come under a dis- 
cussion of health habits. I may say, though, that, if 



282 HEALTH AND THE SCHOOL 

children master the habits we have outUned this evening, 
and spend their days in the vigorous manner suggested 
in our discussion of their daily schedule, they will have 
little time or inclination to cultivate morbid ways. 

Mrs. Ross. — I am impressed with the vigilance it will 
require to see that children form all the good habits you 
have suggested. 

Dr. Latta. — Eternal vigilance you may well call it. 
Children are forming habits of some kind every mo- 
ment of the day. These habits, acquired in school and 
out, at work and at play, are the very essence of their 
education. Shall these habits be good or bad, healthful 
or harmful? Teachers and parents must give the an- 
swer. 

Suggested Reading 

GuLiCK. The Efficient Life. 

Health Education League. Habits of Health. 



XVII 

CALLING THE DOCTOR 

Mr. Young. — The chief concern of our club this year 
has apparently been to learn how to dispense with the 
doctor. Disease prevention has been our main study 
and the securing- of conditions favorable for developing 
the health of children our steady purpose. 

Mr. Martin. — Is the family doctor, then, to become 
a relic of the past, and will the new generation be able 
to regulate that most highly organized of all mechan- 
isms, the human body, without the aid of experts? 

Mr. Young. — Hardly. A landsman can run the ship 
as long- as the wind is fair and the course is set in an 
open sea ; but, when storms or breakers threaten, the 
captain is the only man to be in control. The health- 
iest of us would make sorry work, at times, without 
the doctor. He must still preside at the supreme mo- 
ments of birth and death, and on those other critical 
days when some unpreventable disaster threatens a life 
in the household. 

The complete dependence that we often have to place 
upon him and the serious effects of his decisions upon 
the lives and happiness of ourselves and children make 
our selection of the doctor a very vital responsibility. 
When to send for the doctor and 7vhich one to send for 
are questions that parents are called upon to answer 
from the very first, and the wisdom of their decisions 

283 



284 HEALTH AND THE SCHOOL 

often determines the very lives of their children. This 
evening we shall discuss these two questions, on which 
we are all greatly in need of instruction. Since the 
choice of a physician should always be made before a 
sudden demand for his services arises, we shall first 
consider the question "How to choose a doctor." Dr. 
Latta, who is far too busy to have any personal interest 
in the matter, will open the discussion. 

HOW TO CHOOSE A DOCTOR 

Dr. Latta. — When a father whose child is suddenly 
taken sick runs for the doctor, the chances are four to 
one that he will get an incompetent man. 

Mr. Ross. — What do you mean? 

Dr. Latta. — I mean that about four-fifths of our doc- 
tors have been so inadequately trained that it is dangerT 
ous to trust them with any serious cases. 

Mr. Ross. — I can hardly credit your statement, Dr. 
Latta. Why are such men allowed to practice? 

Dr. Latta. — Because both the federal and the state 
governments have given too little heed to the question 
of medical education. They have failed to realize that 
a properly fostered and regulated medical service would 
do more for the welfare and prosperity of the entire 
country than the best devised tariff or banking system, 
or even a three hundred and sixty million dollar canal. 
Without regard to the dignity of the profession or the 
welfare of the public, they have allowed inferior med- 
ical schools to spring up wherever private greed saw 
probable profit in such a venture. The result of this 
lack of government regulation is that we now have 
about five times as many medical schools as we need, 
and almost four-fifths of them are below the best stand- 



CALLING THE DOCTOR 285 

ards. Many of our states annually turn out hundreds 
of ill-qualified doctors to prey on the public — men who 
have never become acquainted with the human body by 
dissecting it, or learned anything of sickness by seeing it. 

Some of these medical men, to be sure, are gradu- 
ally starved out of the profession, but during their slow 
elimination they are a substantial factor in keeping up 
the death rate. 

Mr. Young. — Would there be enough doctors left if 
the unfit were all to be eliminated? 

Dr. Latta. — Plenty of them. Germany, which main- 
tains the highest professional efficiency of any European 
country, has only one-fifth to one-fourth as many doctors 
as we, and even of this smaller number few are properly 
supported. In our country most of the doctors are actu- 
ally failing to make a living, and many who do manage 
to subsist earn less than skilled laborers do. 

Mr. Ross. — May I ask Dr. Latta how he has been 
able to come by all these interesting and remarkably 
definite figures? 

Dr. Latta. — In answer let me refer you to two very 
important reports on medical education made by Abra- 
ham Flexner for the Carnegie Foundation for the Ad- 
vancement of Teaching.* These reports should be in 
the hands of every intelligent person in the country. 
They are highly instructive and decidedly interesting. 

Mr. Young. — I have been told that these reports are 
so arbitrary and prejudiced that their conclusions are to 
be greatly discounted. 

Dr. Latta. — Have you read them? 

Mr. Young. — No. 

Dr. Latta. — Do so, Mr. Young. The people who 

* Medical Education in the United States and Canada, 1910; 
Medical Education in Europe, 1912. 
20 



286 HEALTH AND THE SCHOOL 

see prejudice in the dispassionate array of facts, not 
opinions, which these reports present are those who sup- 
ply their own. 

Mr. Martin. — Aren't these reports very technical and 
intended merely for medical men? 

Dr. Latta. — By no means. They constitute part of 
much reliable medical information that is now being 
prepared especially for the general public. The time- 
honored policy of medical mystery has been displaced, 
you know, by a determination on the part of our lead- 
ing physicians to share with the public whatever knowl- 
edge will be useful in the common crusade for health. 
The medical profession can make but little further head- 
way in the conquest of disease unless the whole public 
joins in the effort and cooperates intelligently at every 
step. The wonderful campaign against hookworm in 
the South, for example, is primarily a campaign of pop- 
ular medical education. "Making the hookworm inter- 
esting" through moving picture shows and all sorts of 
advertising devices is the chief concern of the able doc- 
tors who are literally transforming the South. 

Miss Parsons. — This new conception of the physician 
as a teacher was strikingly voiced by Dr. John B. 
Murphy in his presidential address delivered at the con- 
vention of the American Medical Association in 1911. 
He said : "It is my belief that public instruction in 
medicine is one of the most important functions which 
the American Medical Association has to perform. For 
centuries we have criticized the public for its lack of 
judgment in its selection of doctors. It has employed 
the quack, the sectarian, the chiropractor, etc. — and more 
enthusiastically supported them than it has the regular 
members of the medical profession. Why? Because 
these men give the patient some kind of explanation for 



CALLING THE DOCTOR 287 

the results they claim to secure. They educate the peo- 
ple in their theories. 

"What has the regular medical profession done to 
educate the public in the last three centuries ? Nothing ! 
What have we taught them of the real truths or prin- 
ciples of scientific medicine? Nothing! What beacon 
have we set for the layman to assist him in the selection 
of a skillful practitioner? None! Up to date the 'pat- 
ent medicine almanac,' quack advertisement, and 'leaves 
of healing' have been the principal instructors of the 
public. So long as they continue to be the only sources 
of public education, just so long the public will be their 
patrons. When we supply the people with their 
medical education, based on science, they will be- 
come affiliated with us and sustain us in our every 
effort." 

Dr. Latta. — Dr. Murphy's strong appeal has won a 
wide response, and his suggestions as to practical ways 
of educating the public are being already effectively car- 
ried out by groups of physicians in all parts of the 
country. 

Now, before we consider what beacon we can set up 
to assist the layman in his choice of a physician, let me 
ask the members of this club what principles they have 
been following in the choice of their own physicians. 

Mr. Ross. — I should say that Mrs. Ross and I hadn't 
followed any principles very consciously. When we 
moved to this town we selected the doctor who had the 
most prosperous looking establishment, attended what 
we considered the "best" families and who seemed to 
have the most to do. After two years we became dissat- 
isfied with this man and chose the physician who ranked 
next in the qualifications I have mentioned. 

Mr. Martin. — I believe Mr. Ross's method of choos- 



288 HEALTH AND THE SCHOOL 

ing a physician is quite typical. I have taken the same 
way myself as far as my pocketbook has allowed. 

Dr. Latta. — Your method of choosing your physician 
was certainly reasonable, provided you had no more ac- 
curate standards by which to measure his competency, 
but, unfortunately, the standards which Mr. Ross has 
advanced do not give his true measure. It is for the 
purpose of bringing out really accurate standards that 
we have been making this apparent digression regarding 
the number and character of the doctors and medical 
schools in the country, and the recent changes in pro- 
fessional standards. Before we can venture to select a 
doctor it is necessary that we have some notion of what 
medical training means. We must know that there are 
a few good medical schools and many poor ones, and we 
must know how to distinguish between them. We must 
also realize the emphasis which the leaders of the pro- 
fession are putting on disease prevention and on public 
education as the most important means to this end. All 
these matters weigh heavily in the proper choice of the 
man who is to take our lives in his hands. We dare 
select no one who cannot pass creditably through some 
such examination as the following: 

I. EDUCATION AND TRAINING 

1. What was his general education before he entered 

a medical school? 

2. From what medical school was he graduated? 

3. What were its facilities — clinics, laboratories, hos- 

pitals, etc.? 

4. What hospital experience did he have before or af- 

ter graduation? 

5. What professional connection has he had with any 



CALLING THE DOCTOR 289 

other physician or institution of estabHshed rep- 
utation? 
What courses of university or cHnical instruction 
has he attended since his graduation from the 
medical school ? 



II. PROFESSIONAL ACTIVITIES AND STANDARDS 

Treatment of Disease. — Does he diagnose and treat 
disease according to modern scientific standards, 
which require : 

(a) Bacterial and chemical tests for the accurate 

determination of certain diseases. 

(b) The use of antitoxins in all cases in which 

their value has been demonstrated. 

(c) Attention to the sanitary care and surround- 

ings of the patient. 

(d) Open-mindedness with respect to therapeutic 

agents other than drugs. 
Prevention of Disease. — Does he strive as energeti- 
cally to prevent disease as he does to cure it? 
(a) Does he observe the sacred law of medical 
cleanliness? For example, does he steril- 
ize his thermometer and other instruments, 
wear cap and gown when visiting a con- 
tagious case, instruct his patients and their 
attendants in methods of avoiding the con- 
tracting or carrying of infection ? 
(&) Does he enforce quarantine regulations or 
does he connive with his patients in evad- 
ing them ? 
(c) What part does he play in the efforts of 
the community to restrict disease? With 



290 HEALTH AND THE SCHOOL 

what organizations or movements is he 
afifiliated ? 
(d) What are his convictions and arguments as 
to the merits of vaccination, vivisection, 
"medical freedom," and other disputed 
health questions? 

III. SUCCESS 

1. What critical cases has he handled and with what 

results ? 

2. What families employ him and in what sort of health 

does he keep them? 

3. What is his present standing with his professional 

associates and with the general public? 

Mr. Ross. — Such an examination, if strictly acted 
upon, would put almost every doctor I know out of 
business. I fear there wouldn't be enough left to go 
round. 

Miss Parsons. — According to the Carnegie report 
there would be an abundance of them left. There are 
many really able physicians who, for lack of social con- 
nections or of suave manners, have failed to win popular 
confidence. These competent men could be substituted, 
with great profit to the public, for certain prosperous 
practitioners whose only claim for fitness are a happy 
bedside manner and the services of an excellent tailor. 
Dr. Latta. — Certainly the only way to discourage 
stupid doctors is to select your men not on the strength 
of a polished or sympathetic bearing, but on the basis 
of scientific training and demonstrated efficiency. Study 
your doctor. Don't leave it to him to tell you how wise 
he is. He may be following the methods of the dark 



CALLING THE DOCTOR 291 

ages. Remember that the slogan of the modern physi- 
cian is : "Turn on the Hght." Look out for the man 
who makes a mystery of all he does, whose conception 
of duty is the mere prescribing of a few medicines for a 
few symptoms, and who stubbornly parries all your 
questions on the assumption that a little knowledge is a 
dangerous thing — for you. It is, to be sure, but not 
so dangerous as none. 

Mr. Martin. — Your words take away my breath, 
Dr. Latta ! I thought it was the cornerstone of medical 
ethics to stand by your fellow physicians through every- 
thing. 

Dr. Latta. — That has been the basic principle of the 
medical profession viewed as a mutual protective asso- 
ciation ; but it is something far grander than that. It 
should be looked upon as a protective association for all 
society. One doctor has no right to defend another 
whose ignorance or avarice is a menace to the public. 

Do not understand me as speaking in disparagement 
of the medical profession. Never before this day has 
it reached such a magnificent conception of its mission 
to humanity ; never before has it grasped the mysteries 
and the control of disease and health as it is doing to- 
day. Just because the medical profession has so much 
to offer, and because the modern physician can be of 
such powerful service, I urge you to choose most care- 
fully the man you call your doctor. 

WHEN TO CALL A DOCTOR 

Mr. Young. — We must know not only how to select 
a doctor, but when to consult him. Most of us have no 
standards for deciding this critical question. "You 
should have called me sooner" is the extent of the in- 



292 HEALTH AND THE SCHOOL 

struction which we have received on this point. Dr. 
Latta will explain to us what is meant by "sooner." 

Dr. Latta. — There is no matter on which the medical 
profession so clearly needs to instruct the laity as just 
this. Speaking- approximately, I should say that one- 
third of the people who consult physicians are suffering 
only from slight disorders that hygienic habits would 
have prevented and would still correct, while, on the 
other hand, more than half who do seek advice arrive 
too late to be cured. 

Mr. Ross. — To be on the safe side, then, is it not 
better to let the doctor decide whether he is needed or 
not? 

Dr. Latta. — If you mean that every one should occa- 
sionally be looked over by a physician to see that he is 
sound, I should say most emphatically yes. The an- 
nual physical examination which our school children now 
receive is necessary for discovering many defects and 
morbid conditions which would otherv\?ise either remain 
undiscovered or be detected too late. The desirability 
as well as the economy of the periodic medical exam- 
ination is already recognized by certain shrewd life in- 
surance companies. Some of them offer their policy 
holders a free medical examination annually, and others 
go so far as to grant one whenever it is requested. A 
periodic examination is a powerful safeguard against 
the encroachment of serious chronic ailments, and should 
constitute a part of every one's annual program, just as 
surely as the summer vacation or the celebration of 
Christmas. 

In the handling of acute conditions, however, the doc- 
tor is not always so important a figure as certain prac- 
titioners would have you believe. To be sure, if a 
patient and his friends are so uninstructed that they 



CALLING THE DOCTOR 293 

cannot conjecture whether a pain arises from green 
apples or cancer, it is well to call some one who can ; 
but such helpless dependence is not necessary and it is 
not encouraged by the best men in the profession. A 
physician with serious work to do teaches his patients 
to take some responsibility for their own health, to cor- 
rect their own slight disorders, and to remove the causes 
of them, too. 

Mr. Martin. — What do you call slight disorders? 

Dr. Latta. — I will enumerate them in a moment but 
before I do, I wish to make it clear that the list of 
symptoms which I shall offer must not be regarded as 
an infallible guide. The human frame is the most intri- 
cate and variable mechanism on earth and even the great- 
est diagnostician living would never venture to speak 
with certainty upon its condition unless he could con- 
firm his opinion by a rigid laboratory test. 

Mrs. Ross. — If it is so extremely difficult to make an 
accurate diagnosis, is it not reckless folly for a layman 
to attempt one under any circumstances? 

Dr. Lx\tta. — If every case required an expert diagno- 
sis it certainly would be, but, fortunately for the human 
race, a rough and ready diagnosis is usually the right 
one. A certain set of easily recognized symptoms ordi- 
narily indicates a certain well-known ailment, though, of 
course, there is always the chance that it does not. 

Miss Parsons. — I suppose if we allowed ourselves to 
take no chance at all on our health or personal safety 
we should be too wholly absorbed to permit ourselves 
any other occupation. 

Dr. Latta. — Exactly. It would be idle for me to urge 
everybody to run to the doctor whenever he feels a little 
twinge or uneasiness. It is certainly the safest thing to 
do but it isn't a practical thing to do. I therefore consider 



294 HEALTH AND THE SCHOOL 

it of the highest importance for patients to know as 
definitely as they may the degree of chance they may be 
taking under various circumstances in neglecting to see 
the doctor, so that they need take no serious chance at 
all. Admitting that they always run some risk in look- 
ing after their own ailments, I am, nevertheless, going to 
give you a list of symptoms that ordinarily need cause no 
serious concern, and that are likely to yield to simple 
home treatment without the aid of a physician. 

I do not claim that a single one of these symptoms 
may not indicate a dangerous condition. I have, in fact, 
met in my own practice very serious cases of appendi- 
citis whose presence was manifested to the patients 
merely by some flitting pains and a slight general feel- 
ing of sickness. I have known a child with a fractured 
bone in her arm going about her play with little com- 
plaint of pain or loss of motion. Such cases, however, 
are most exceptional. Serious cases are usually indi- 
cated by definite symptoms, and it is in order that we 
may run no risk on these that we must distinguish them 
sharply from conditions that ordinarily need cause but 
slight concern. For convenience we shall group the less 
serious symptoms under six heads : 

1. Pains without fever, that last but a short time and 

do not recur. 

2. Moderate fevers that begin to subside as soon as the 

bowels have been thoroughly discharged and 
which are unaccompanied by eruptions, colds, sore 
throat, or vomiting. 

3. Digestive upsets unattended by fever or exhaustion, 

or severe, prolonged, or recurrent pain. 

4. Colds and coughs of short duration, which are un- 

attended by fever or marked debility. 



CALLING THE DOCTOR 295 

5. Wounds that can be thoroughly cleansed by home 

treatment, and are evidently able to unite with- 
out stitches. 

6. Strains and bruises that do not impair freedom of 

joint or limb, cause no constitutional derange- 
ments, and in which swelling and pain subside 
within a day. 

It is important, of course, to learn from a physician — 
never a druggist — the best ways of treating these minor 
ailments, and of preventing such as are preventable. This 
highly important knowledge, which is easily acquired and 
is in no way dependent upon previous technical training, 
should be sought by all responsible persons, and, most of 
all, by mothers and teachers. 

The presence or absence of fever, a most important 
item in every diagnosis, is not a condition which it re- 
quires the visit of a doctor to determine. A clinical 
thermometer in the hands of a mother or teacher tells 
the story just as well. This instrument should be in 
every home and school. It is indispensable for forming 
any intelligent judgment as to the condition of an in- 
disposed child, and its use not only saves doctors' time 
and patients' money, but on occasion gives the only in- 
dication of the urgent need of a physician. 

Mrs. Ross. — Having learned now under what circum- 
stances we need not call a physician, are we to assume 
that he will be required for all our other physical ills? 

Dr. Latta. — He certainly should be consulted about 
any morbid symptoms that vary from those in the list 
I have given, as there is a strong likelihood that they 
indicate a definite disease, more or less serious. Re- 
member that the most critical matters to observe in de- 
termining the seriousness of a case are fever, pain, and 



296 HEALTH AND THE SCHOOL 

exhaustion. A fever that does not yield after a clearing 
out of the bowels calls for medical attention ; so do 
continuous pain and exhaustion. In fact, any unfavor- 
able condition that does not soon correct itself should 
have the attention of a physician. Recurrent headaches 
and backaches, abdominal pains, swellings, and enlarged 
glands, persistent lumps, loss in normal weight, and any 
other mild but lasting symptoms require medical care. 
They should never be prescribed for by a druggist. 

Mr. Martin. — You have not mentioned eruptions or 
sore throats. Are these not often very serious symptoms 
with children? 

Dr. Latta. — To be sure, and their seriousness is usu- 
ally indicated by accompanying fever or exhaustion, for 
which you are always to be on your guard. Sore throats 
and eruptions, even when unaccompanied by fever, occa- 
sionally indicate light forms of contagious disease — 
measles, chicken pox, whooping cough, diphtheria, or 
scarlet fever. A child with such symptoms should al- 
ways be isolated and examined by a doctor. A combina- 
tion of cold or sore throat or vomiting, together with an 
eruption, almost invariably indicates a contagious disease, 
and, while very seldom occurring without fever, calls 
for immediate medical attention, whether accompanied 
by fever or not. 

I will spare you a detailed account of the symptoms 
of the various diseases. Recent books on the health of 
children abound in diagnostic tables for the use of teach- 
ers and patients, and you can easily look up the particu- 
lar shade of pallor or flush which matches the color of 
your child. We are interested now not in learning how 
to pronounce on certain diseases, but in learning how 
to tell whether we need the doctor for this purpose. 
As you have seen, the considerations which determine 



CALLING THE DOCTOR 297 

the need of a doctor are simple and few. Let us sum 
them up now in brief form, easy to remember. 

A doctor should be consulted at the following times: 

1. At regular intervals of not more than a year, in 

order to guard against obscure defects and ail- 
ments. 

2. Whenever lassitude, pain, swelling, or fever are not 

promptly relieved by rest, soothing applications, 
or a cleansing of the intestines. 

3. When there is sore throat. 

4. When colds and sore throats are accompanied by 

fever, rash, or vomiting. 

5. When any unfavorable symptoms become chronic. 

6. When accidents are of such a nature that there is 

any doubt as to the best treatment to be followed. 

To follow these simple rules in sending for the doctor, 
instead of relying merely on one's state of alarm, is to 
substitute a reasonable degree of assurance for uncer- 
tainty and to increase very considerably the chances of 
good health and long life for one's self and one's chil- 
dren. 

Suggested Reading 

Carnegie Foundation for the Advancement of 
Teaching. 

(i) Medical Education in the United States and 

Canada, 1910. 
(2) Medical Education in Europe, 1912. 
For aids in diagnosis see references at end of Chapter 
IL 



XVIII 
HEALTH PROBLEMS IN CHILDREN'S INSTITUTIONS 

Mr. Young. — In outlining a health program for chil- 
dren Dr. Latta has had much to say about the respon- 
sibility of parents. What is to be done for children 
who have no parents or such as cannot care for them? 
In our town there are about 200 children of this sort. 
While we are discussing means for improving the con- 
dition of our more fortunate children, we cannot over- 
look the orphans. Mrs. Ross, as a trustee of the County 
Orphanage, has asked that we devote an evening to the 
special health problems of children's institutions. Dr. 
Latta will open the discussion. 

Dr. Latta. — The best institution for children who 
are not sick or disabled is the one that has closed its 
doors. 

Mr. Ross. — May I ask what you mean by that cryptic 
remark? Should the children be locked in or out? 

Dr. Latta.i — Out, sir. It is neither desirable nor 
necessary that normal children be permanently kept in 
institutions. 

Mr. Ross. — What other places are there for them? 

Dr. Latta. — Private families, no end of them. Any 
genuine orphan without serious defects can actually 
have his choice of desirable homes. Australia has some- 
thing to teach us in this matter. The word orphan is 
not used there, nor are there any orphan asylums. In 

298 



CHILDREN'S INSTITUTIONS 299 

South Australia in 191 1 the Children's Council had 1,479 
children under its control, of whom it boarded out 1,220, 
put 7 in hospitals, and 32 in institutions for defectives 
and delinquents. The outlay for each child boarded 
out, including administration expense, was $60 a year, 
which is $40 less than the minimum expense for a child 
in our poorest institution, and $140 less than in our 
most lavish ones. Besides being in a more normal en- 
vironment at less expense than possible under institu- 
tional care, the children of Australia, after they are 
thirteen years old, are given a chance to better their 
own condition. In 191 1 some of these children, by 
working part time, earned and deposited $6,500 in the 
postal savings bank. 

That the children do not suffer from the economy and 
simplicity of the boarding out system is strikingly 
shown by the reduction of mortality among illegiti- 
mate children, which has shrunk from 27 per cent, 
to -1.58 per cent, since the Children's Council began its 
work. 

Mr. Ross. — Australia is pretty far away. The con- 
ditions may be so different there that the methods em- 
ployed in meeting them would fail when applied to our 
problems. It seems to me far better to have children 
kept in well-run institutions than trusted to a miscel- 
laneous assortment of families who, like as not, would 
want to exploit them under the pretense of giving them 
home care. 

Dr. Latta. — Such a criminal way of disposing of chil- 
dren, while frequently practiced in the past, is hardly 
possible under the present approved method of selecting 
homes. This provides for a very careful investigation 
and continued observation of the families to which chil- 
dren are sent. Officers who could not be trusted to do 



300 HEALTH AND THE SCHOOL 

such work could certainly not be depended upon to run 
institutions properly. 

The placing out system for children is, in fact, no 
longer an experiment. Australia is not alone in dis- 
covering that good private homes are far more desir- 
able places for children to grow up in than even the 
best institutions. Our progressive states are all finding 
this out. Massachusetts in the last fifteen years has 
closed down thirteen institutions for children, though 
its population has increased greatly in that time. In- 
diana has similarly closed twelve of its fifty county chil- 
dren's homes, and is preparing to discontinue others. 
These changes in each state have been made possible 
by an extension of the placing out system. Michigan, 
Minnesota, Wisconsin, and Rhode Island each conduct 
but one central state school for dependent children; the 
policy being to retain the children there only so long 
as is necessary to find suitable free homes for them, 
and to prepare them for entering these. The results in 
the four states indicate conclusively that this mode of 
caring for motherless children is the best as well as the 
most economical that has so far been devised. Minne- 
sota and Michigan particularly, having been almost en- 
tirely free from political interference, have met the 
needs of their children more adequately than any of our 
other states, and at a cost that seems incredibly small 
as compared with amounts elsewhere expended. 

Miss Parsons. — Just a word at this point. Minne- 
sota and Michigan undoubtedly lead the other states in 
the success with which they have carried out their par- 
ticular method. But, good as it is, it is not the last 
word in the care of a certain class of children now 
ranked as dependents. Some of our western states have 
lately taught us a lesson so obvious that we wonder why 



CHILDREN'S INSTITUTIONS 301 

we have waited so long- to learn it. These states have 
concluded that the best possible way to arrange for de- 
pendent children who are not motherless is to board them 
with their own mothers. This arrangement provides for 
a large proportion of children who need public aid. The 
mother can rear her own children both more successfully 
and more economically than can any other woman who 
is paid to do it. 

Mr. Ross. — Do you mean that public money should 
be given to mothers for bringing up their own children? 

Miss Parsons. — To be sure, if that is the only con- 
dition on which worthy mothers can fulfill this most 
important public task. The arrangement known as 
"mothers' pensions" has made such a wide appeal that it 
was considered by fifteen state legislatures in 1913. 
There are already nine states which have adopted this 
way of safeguarding their children until the time when 
a universal compulsory insurance system, such as is in 
successful operation in Germany, will secure for each in- 
dustrious family an unbroken circle. 

Mrs. Ross. — Is the mothers' pension system really 
working out well where it is in operation ? I have heard 
rather contradictory reports about it. 

Miss Parsons. — No one claims that the results have 
thus far been ideal. They cannot be so until an ideal 
system of administration has been evolved and that may 
not be for years. Any pension scheme whose operation is 
dependent on the discretion of officials is open to abuse ; 
but present imperfections of method do not in the least 
impair the soundness of the theory upon which mothers' 
pensions are based. 

Dr. Latta. — It is not, of course, the purpose of this 

evening's discussion to weigh the relative advantages of 

home and institutional care of children. The question, 
21 



302 HEALTH AND THE SCHOOL 

indeed, admits of no discussion. We have a reason, 
however, for emphasizing incidentally the desirabiHty of 
avoiding institutional care for children whenever pos- 
sible. Just now a strong sentiment is springing up in 
our town in favor of enlarging the capacity of our county 
orphanage. Such a step is both unnecessary and unde- 
sirable. It is true that there are children who now need 
its protection and for whom there is at present no room, 
but how many children do you suppose there are among 
the two hundred already there who would not be better 
off if placed in private homes ? Not more than five. If 
it is desirable to continue the orphanage at all, let us 
make it primarily a receiving station, from which the 
children can either easily return to their own homes 
when conditions are improved there, or to other homes 
or special institutions better fitted for them. 

Mrs. Ross. — Among the advantages of the private 
home do you include conditions more favorable to 
health ? 

Dr. Latta. — Most decidedly. For children less than 
six years old experience has shown up to the present 
time that, without a single exception, institutional care 
is the most deadly kind of care. There is to-day an 
orphan asylum in Philadelphia in which the mortality 
of babies under one year old is about loo per cent. 

Miss Parsons. — I see that the Child Helping Depart- 
ment of the Russell Sage Foundation has recently made 
a study of the sanitation of foundling asylums, and has 
brought out a set of plans for such institutions which 
call for extraordinary sanitary precautions. 

Dr. Latta. — This study will doubtless prove highly 
valuable when the results are widely known and acted 
upon. In the meantime babies should be kept out of 
institutions. 



CHILDREN'S INSTITUTIONS 303 

After the first tender years, children resist the strain 
and limitations of institutional existence rather better, 
and in the most enlightened institutions survive the ills 
of childhood as safely as in ordinary family life, possibly 
more so. It is only one institution in a thousand, how- 
ever, that can make such a claim. The New York 
Orphanage at Hastings-on-Hudson and the Seybert In- 
stitution for Children at Meadowbrook, Pa., are such 
institutions. They are remarkable examples of what 
ideal physical conditions, wise direction, and abundant 
funds can do for the health of institutional children. In 
referring to the scarcity of contagious disease in his 
institution, the superintendent of the New York Orphan- 
age, Mr. Rudolph R. Reeder, said, toward the close of 
January, 191 3: 'This is our eleventh winter in this 
Home and the hospital has been closed eight of these win- 
ters including the present. This means that during the 
eleven years we have lived here 200 children have passed 
through eight winters without any of the forms of con- 
tagious sickness requiring hospital treatment." 

The Seybert Children's Village, which accommodates 
100 children, has also been highly successful in holding 
off contagious disease. Among the 650 children ad- 
mitted during the six years of its existence the number 
of cases of serious contagious disease, with the exception 
of whooping-cough, stands at the following surprisingly 
low figures : 

Measles 24 

Chicken Pox 15 

Diphtheria i 

The whooping-cough which invaded the institution 
during one winter we will refer to later. 

The very success of the institutions just named is in 



304 HEALTH AND THE SCHOOL 

itself an argument for closing the doors of many others. 
Without the ample income, the wholesome country loca- 
tion, and the exceptionally wise management which these 
two orphanages enjoy, the average institution stands 
no chance of even approaching their standards of effi- 
ciency. Listless, undergrown children, with little 
strength to resist disease, and little energy to make their 
way, are the products of most children's institutions 
as now conducted. By having the children for the 
most part placed in private homes, much of the energy 
and money which are at present spent in running poorly 
hundreds of unnecessary institutions could be diverted 
to the support and conduct of a few necessary and highly 
efficient ones. 

Mr. Young. — What do you regard as necessary in- 
stitutions for children? 

Dr. Latta. — Hospitals for the sick; asylums for de- 
fectives, such as the feeble-minded, deaf, blind, and 
epileptic ; school homes for the delinquent ; and tempo- 
rary homes for normal children who are destitute and 
neglected. Such institutions as these society will always 
have to support, either through charity or taxation. 

Society not only will have to support such institutions 
but it will have to supervise them, whether they be public 
or private. If our school children have need of public 
health supervision, our parentless institutional children 
have far greater need. Shall we allow it to be possible 
for long, do you think, to find, as I did a short time ago 
in the orphan's home to which I referred, a dormitory 
in which lOO boys slept and in which there were just 3 
windows ? 

Economical no less than humane considerations make 
the safeguarding of the health of the children in 
institutions a matter of the very greatest importance. 



CHILDREN'S INSTITUTIONS 305 

It is, moreover, a matter presenting peculiar difficulties, 
as the mere bringing- together of many children to live 
under one roof and one central management complicates 
highly the problem of securing the best health conditions 
for each. Let us now^ see just what the complicating 
factors are and how best to overcome them. 

We will suppose that the health conditions which we 
have noted as necessary for children in families are met 
as they should be in a children's institution; that fresh 
air, good food, proper clothing, and play space are all 
provided in abundance. Not that this is often the case, 
but even when it is there are two further provisions 
which, though needing little consideration in pri- 
vate families, cannot be neglected in institutions with- 
out the gravest danger. These are (i) precautions 
against contagion; (2) precautions against dezitalidng 
routine. 

Mr. Ross. — The need for taking precautions against 
contagion is, of course, apparent where you have so 
many children living together. The second need I fail 
to appreciate. How can you care well for children and 
train them, too, without making the whole process one 
of routine? 

Dr. Latta. — If you will bear with me just a moment 
while we discuss the subject of contagion, I think I can 
show you that a too rigid routine for children is as great 
a menace to their health and vigor as a too general dis- 
tribution of germs. 

CONTAGION 

A children's institution affords an ideal arrangement 
for the spread of contagion. Day and night, at play, at 
work, at meals, and at rest, numbers of children are 



3o6 HEALTH AND THE SCHOOL 

close together with every opportunity for passing in- 
fection from one to another — unless the strictest watch 
is kept and the most rigid regulations enforced. The 
ease with which frequent and devastating epidemics can 
spread in institutions is shown in tragic, chapters from 
the annals of almost every one whose history covers 
more than a year or two. And yet institutional condi- 
tions can be so controlled as actually to provide greater 
safety from contagious diseases than can possibly be 
secured in any ordinary well-regulated family. 

Mr. Ross. — How in the world 

Dr. Latta. — Nothing easier. Contagious diseases are 
spread almost entirely by direct or indirect contact with 
those suffering from them or by contact with people, ani- 
mals, or even articles that have been infected by them. 
If everyone who either has a contagious disease or has 
been exposed to one, and every article which may con- 
tain infection, is kept away from children, no contagious 
disease can reach them. 

To exercise the vigilance necessary to secure such 
absolute freedom from infection is quite impossible in 
a normal family, for the members cannot avoid mingling 
with the general public among whom virulent disease 
germs are as yet always lurking. A children's institu- 
tion, on the other hand, can easily meet the conditions 
necessary for excluding contagious diseases. It is in 
itself a little world whose entire public can be placed 
under the strictest scrutiny. 

In addition to the care that is necessary in any com- 
munity for securing a safe food and water supply and 
a sanitary waste disposal system, there are two measures 
which, if faithfully carried out, make a children's in- 
stitution practically contagion-proof. These are : ( i ) 
isolation of all entering inmates until it is demonstrated 



CHILDREN'S INSTITUTIONS 307 

that they arc free from contagious disease or infection 
of any kind; (2) immediate and complete isolation of 
any inmate xvho sJiozvs the least deviation from normal 
health. Institutions where these rules are strictly car- 
ried out have no epidemics. The contagion is blocked 
at its first appearance both without and within the 
fold. 

1. Isolation of Entering Inmates. — A thorough medi- 
cal examination should be promptly given to every child 
on entering an institution, and until he can show a clean 
health bill he should be detained in a receiving cot- 
tage or wing entirely apart from the other children. 
This simple precaution is a most effective guard to the 
health of the entire institution. It should be practiced 
inflexibly, no matter how unnecessary it may appear to 
be in certain cases. A perfectly well child may be a car- 
rier of virulent disease germs. This has been demon- 
strated again and again when the unsuspected source of 
some mysterious epidemic has finally been traced to a 
healthy "carrier." No chances should be taken on a 
possible "carrier" in an institution. Risks that can be 
lightly taken in families are fraught with almost certain 
disaster in institutions. The only real safety from con- 
tagion among large numbers of children lies in the elimi- 
nation of all risk. 

2. Immediate Isolation of Sick Children. — In addition 
to the strict guard that must be kept against outside 
infection, it is further necessary that each child within 
the institution be under trained and watchful eyes every 
day. Under cottage management (the best system for 
providing children with personal care) it is easy for 
the house mother to observe promptly any untoward 
symptoms that may appear among her children. 

The child who is affected should be instantly with- 



3o8 HEALTH AND THE SCHOOL 

drawn from the group and placed either in an isolated 
room in his own cottage or in the institution infirmary 
until the nature of his sickness is determined. Such 
prompt care is no less desirable for the child himself 
than for the others who might be infected by him. 
Many a serious illness can be checked if promptly recog- 
nized and correctly treated. Constant scrutiny of the 
children and immediate isolation and care of the sick 
are the first duties of the house mother who would avoid 
trouble. 

Mrs. Ross. — May I ask whether an ordinary cold 
should warrant the isolation of a child. 

Dr. Latta. — A child just coming down with a cold 
should always be isolated, as he may be exhibiting the 
first symptoms of a serious contagious disease, particu- 
larly measles or whooping-cough. A cold itself, as you 
know, is very contagious and every case should be kept 
isolated, if possible, until the acute stage has passed. 
Mothers who find this an irksome requirement, often 
experience the alternative of having all their children in- 
stead of one, ill with colds. When children with colds 
cannot be completely isolated, every reasonable care 
should be taken to prevent them from passing their 
germs around. They should always be carefully trained 
in the use of individual toilet articles, handkerchiefs, 
towels, tooth brushes, and combs, and in the practice of 
considerate hygienic habits, such as turning away from 
people and covering their noses and mouths when sneez- 
ing or coughing. 

The most successful way to avoid colds among chil- 
dren is to develop their own powers of resistance through 
plenty of good food, fresh air, and exercise. Germs 
gain little foothold among children who enjoy such a 
regime. In the Children's Village of the Seybert In- 



CHILDREN'S INSTITUTIONS 339 

stitution no attempt is made to isolate children with 
colds. The constitutional tone of the children is so 
good, however, that the rare cases of cold which occur 
there do not multiply. 

When a contagious disease does crop out under the 
guise of a cold, however, it spreads rapidly among chil- 
dren of even such high resisting power as those in the 
Children's Village. The one real epidemic that has vis- 
ited this institution was due to whooping-cough, which 
attacked about one-third of the whole population in a 
single winter. It is possible that a general policy of 
putting a strict quarantine on every child who showed 
the first symptom of cold or cough would have pre- 
vented this epidemic. Not having observed the conditions 
in the Village at the time, however, I offer this sugges- 
tion not as a criticism but as a query. 

ROUTINE 

The deadly effect of institutional routine manifests 
itself in two distinct ways, on the body and on the mind. 
Many children cannot endure an unyielding daily sched- 
ule which includes fixed diet and dress, hours of obliga- 
tory study and work, and their health suffers accord- 
ingly. As we have learned in our earlier discussions, 
a child's daily routine, including what he eats and wears, 
should be devised especially for him. To make inflex- 
ible arrangements for a miscellaneous group of children 
is like providing each with a coat of one size. Some 
are not covered while others are swallowed up. The 
requirements of an institution should never become so 
fixed that the daily program cannot easily be modified 
to suit the needs of individual children, nor should the 
supervision be so scanty that children who need special 



3IO HEALTH AND THE SCHOOL 

attention can fail of detection on the part of those in 
charge. 

In the so-called congregate form of institution, un- 
less the number of children is very small, fifty being 
the maximum, it is impossible to give the necessary at- 
tention to individual needs that can be given under a 
well-conducted cottage system ; nor is it even possible 
to introduce changes which the whole group may greatly 
need when every detail in the machinery is run accord- 
ing to directions issued months in advance, as is often 
the case. 

Direct Physical Effect. — Not the least of the difficul- 
ties in adapting institutional conditions to the needs of 
children lies in the inflexible dietary which has to move 
in the line of least resistance when large numbers are 
to be fed. The wholesome exhilaration that children 
experience, for instance, in securing some specially 
longed-for table treat is an unknown delight to those 
who are fed on the congregate plan, and whose meals 
are often served according to a prescribed weekly sched- 
ule made out with little respect to changing seasons 
and markets or the seasonal cravings of children. 

Miss Parsons. — In citing the greater freedom in diet 
which is possible under the cottage system, Mr. Reeder 
tells of a group of boys who begged the cook to make 
pancakes for breakfast. "When she protested that mak- 
ing pancakes for twenty-five boys was beyond her capac- 
ity, they gladly took the responsibility upon themselves, 
and a great feast of pancakes was spread the next morn- 
ing. That was but the beginning of innumerable forms 
of catering to their taste now going on every day in the 
various cottages." 

Mr. Ross. — Isn't there danger of tempering the wind 
too much for those dependent children? The world, 



CHILDREN'S INSTITUTIONS 311 

when they get out into it, won't give them pancakes 
just because they want them. 

Dr. Latta. — But they will be the better able to se- 
cure their own pancakes for having had them in their 
youth. A growing child derives much of his joy and 
all of his energy through the satisfaction of his active 
stomach. Dependent, defective, or delinquent though 
he be, his need for enjoying food is as great as it is 
with our own Tom or Harry. 

The desirability of giving even orphan children meals 
that they enjoy was suddenly brought home to the New 
York Orphan Asylum a few years ago, when it was 
found that more than half of the children were under 
standard height and weight. The management imme- 
diately set about making their meals attractive. Sur- 
prises and relishes that were nourishing were placed on 
the diet. Muffins and appetizing soups, smoked and 
salt fish of various kinds, fruit sauces, and alluring des- 
serts were introduced, to the great delight of the chil- 
dren. 

This vigorous diet reform brought about an instant 
and startling result. Beginning at once, the proportion 
of children above standard weight and height increased 
rapidly until in two years, instead of being only half 
of the number below, it had come fully up to standard. 
As no change in the environment other than the im- 
provement in diet was made during this time, the change 
in the children can very safely be attributed to this 
factor. 

I have cited the matter of food as merely one of the 
items of the physical environment which should be con- 
stantly adapted to the changing needs and legitimate 
desires of the children. There are many others. The 
weight and even style of clothing, the hours of sleep or 



312 HEALTH AND THE SCHOOL 

rest, the violence of play, the amount of work — all these 
details should be carefully adjusted to the requirements, 
capacities, and even the tastes of the individual chil- 
dren. 

Mrs. Ross. — In our county orphanage we have found 
that it facilitates individual adjustments to have children 
of widely different ages in the same cottage. The needs 
of these children are so various that it is quite necessary 
to arrange for them individually. 

Mr. Young. — This arrangement has the additional 
value of providing a greater variety of interests for the 
children. Each year of life has interests of its own, and 
little children, as well as older ones, can share each 
other's experiences with mutual profit. 

Dr. Latta. — Mr, Young's point suggests the effect 
that an overemphasized or monotonous routine has upon 
the mind and indirectly upon health. 

Mental Effect. — Through its paralyzing efifect on the 
spirit and will, a too mechanical regime lowers the whole 
nervous tone of the children and the energy of all their 
vital functions. This effect, though brought about 
through a mental state, shows itself in stunted growth 
and poor accomplishments, just as palpably as if caused 
by insufficient food or air. The digestion of children, 
for instance, in institutions which enjoin complete silence 
during meals — and there are many of these — cannot be 
as sound as that of children who are allowed a moderate 
degree of conversation and merriment while eating. 
Life means literally nothing either to adults or to chil- 
dren unless it permits of some independence of action, 
whether of work or play, some freedom to chase rain- 
bows, some chance to convert hopes into realities. If 
the opportunity for such initiative is denied the central 
dynamo is checked and all the forces of growth with it. 



CHILDREN'S INSTITUTIONS 313 

Mrs. Ross. — In the most progressive institutions, chil- 
dren are permitted much variation in their dress. The 
institutional uniform is recognized as destructive both 
to taste and self-respect. No emblem could mark more 
emphatically the humiliation and hopelessness of the 
average orphan's plight than the shapeless, monotonous 
garments that proclaim their wearers the inmates of 
certain institutions. Even when economies must be 
sharply made, it is possible to grant a little latitude in 
dress. Merely a collar or a ribbon of a small girl's own 
choosing is a source of joy and inspiration to her. 

Mr. Ross.— Are there any actual statistics that show 
the harmful effects of routine or the favorable effects of 
freedom on the physiques of children? 

Dr. Latta. — It would seem a rather odd experiment 
to try to state the effect of hope and joy and independ- 
ence in terms of pounds and inches. As far as I know, 
there has been no attempt to make quite so bald a dem- 
onstration. I have some figures here, however, which 
are very suggestive. The children in the New York 
Asylum whose growth we have just seen to have been 
remarkably advanced by an improvement in their diet 
showed as much gain again when they were moved into 
the country and suddenly freed from countless restraints 
which had been necessary in their city home. During 
seven years, which included two years of city residence 
and five years of country life, the children showed the 
following variations from normal standard in weight 
and height : 

1900 1901 1902 1903 1904 1905 igo6 

No. above standard average in 

both weight and height 39 52 67 66 80 78 ^2 

No. below standard average 

in both weight and height. .87 (^ 67 62 49 54 55 



314 HEALTH AND THE SCHOOL 

The first measurements in 1900 to which we have al- 
ready referred showed the number of children below 
standard weight and height to be more than twice as 
great as the number above. The effect of the vigorous 
diet reform is plainly indicated in the figures for 1901 
and 1902. In 1902 the institution was moved to the 
country and the congregate form of housing replaced 
by the cottage system. A much freer life was now pos- 
sible for the children. Opportunities for play were 
greatly broadened, and many restraining rules that had 
been necessary in the confined city quarters were lifted. 
The improvement in the children following this change 
was as pronounced as their improvement following the 
change of diet. This time the number of children above 
standard, instead of remaining equal to the number be- 
low, within two years exceeded by over 50 per cent, the 
number of children below standard. 

Miss Parsons. — Do you attribute this remarkable im- 
provement largely to the new freedom from restraint? 

Dr. Latta. — Very largely. The freer, more home- 
like atmosphere of cottage life, the wide range of coun- 
try open for the children's work and play, the opportu- 
nity to cultivate individual gardens, to build play houses, 
to swim in the river, to climb trees, and roam in the 
woods — all these enlarged privileges, while benefiting 
the children directly by securing for them better care, 
fresh air, and exercise than they had ever known be- 
fore, were most dearly prized and, therefore, most stim- 
ulating to health on account of the coveted freedom 
which they involved. 

Mr. Young. — Let us take a moment now in closing 
to sum up the important principles which have been 
brought out in this evening's discussion. 

The problem of rearing children in institutions has 



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CHILDREN'S INSTITUTIONS 315 

evidently two very definite aspects, the physical and the 
psychical. The physical environment should be main- 
tained according to modern scientific standards, which 
include the items of suitable food, air, and play space, 
and also the important matter of excluding- and check- 
ing contagious diseases. The right psychical environ- 
ment is no less important. Children in institutions need 
both more freedom and more attention than they are 
wont to receive. 

Nature has arranged that her human young shall be 
brooded over in small numbers for many years by the 
most watchful and at the same time the most indulgent 
care that life in any of its phases has evolved. Hired 
supervision of larger numbers of children than are natu- 
ral to a family can never even approximate in efficiency 
the loving care that is bestowed by a mother on her own. 
All the more important is it, then, to make the fullest 
possible efforts to individualize institutional children and 
to satisfy their wholesome personal cravings as any 
mother would. 

Suggested Reading 

Hart. Preventive Treatment of Neglected Children. 
Reeder. How Two Hundred Children Live and Learn. 
Russell Sage Foundation. 

Cottage and Congregate Institutions. 

Receiving Home for Foundlings and for Mothers 

zvith Their Babies. 
Smedley. Institution Recipes. 



XIX 
THE RELATIVE COST OF HEALTH AND DISEASE 

Mr. Young. — Every health reform which we have 
discussed this year has promptly been challenged by 
the query, "What will it cost ?" The question is not out 
of place. If health costs more than disease, it is evi- 
dently economy to choose disease. 

Miss Parsons. — But what is economy for? What 
value has it if its price is human health or life? If a 
community must scrimp on its health, what reason has 
it for existing? 

Mr. Young. — None whatever, it seems to me; and 
yet our taxpayers do not all share this reasonable view. 
Some of them are grumbling at the increased expense 
which our new system of medical inspection has added 
to the schools. Many are opposing the erection of a 
sorely needed filter plant. Others are scoffing at what 
they term the extravagance of our proposed plan for 
milk inspection. Nothing but proof that these new out- 
lays will pay a money profit will convince such people 
that they are worth while. Can we furnish them with 
the proof? Mr. Ross, who has consistently kept us 
from being carried away by sentiment this year, will 
present us with some facts concerning the relative cost 
of health and disease. 

Mr. Ross. — I trust my report to-night will square 
me for the various ill-considered objections I have made 

316 



THE COST OF DISEASE 317 

during the year to the pohcies suggested by Dr. Latta, 
Miss Parsons, and the others for improving the health 
of our school children. My criticisms must he laid to 
an incomplete knowledge of the facts, for, with new in- 
formation, I am ready to testify to the wisdom, as well 
as the economy, of every plan that has been seriously 
worked out in this club. 

The ancient truth that an ounce of prevention is worth 
a pound of cure has finally reached me. Calculated in 
dollars and cents I have found that the relative cost of 
disease and health really exceeds the ratio of 16 to i. 
The evidence stares us in the face on every side. For 
any one who doubts, the amazing record made in Pan- 
ama alone is a final answer. When France, in 1889, 
abandoned her tragic effort of eight years to build a 
15-foot canal down there, she left the country full of 
dead men and brought home with her a deficit of over 
$300,000,000. An equal outlay of money on the part 
of the United States is now bringing a 40-foot canal to 
completion with an ease and swiftness which are amazing 
the world. 

Scientific management may justly claim credit for the 
speed and economy with which the work is being car- 
ried out. To modern sanitation, however, which is the 
art of preventing disease, belongs the credit of making 
the undertaking possible at all. If the pestilences which 
mowed down the workers faster than they could be 
brought to Panama had not been checked, the canal 
could never have been completed. To hold off these 
diseases has cost something. Money has been poured 
out in Panama as nowhere else in the world, merely to 
save the health of the laborers, six-sevenths of whom 
are ignorant blacks. In spite of the ignorance and care- 
lessness of the mass of the population, the death rate 
22 



3i8 HEALTH AND THE SCHOOL 

has gone down and down, finally, in March, 191 1, reach- 
ing the unexampled level of 8.91 per 1,000, which is 
almost 50 per cent, lower than the average death rate 
in the United States of 163^ per 1,000. At one time, 
under French control, the mortality in Panama reached 
the incredible figure of 170 per 1,000. 

The motives which have prompted our outlays for 
health conservation in Panama have not been humani- 
tarian. They have been strictly economic and in that 
very fact lies their tremendous importance. It is only 
a paying policy that society in the long run can hold to. 
Now, if it is profitable to pay whatever it costs to main- 
tain health in pestilential Panama, what profit may we 
not expect from a similar course in our own country, 
most of which is already blessed with a naturally health- 
ful climate and soil ? To maintain as low a death rate in 
the United States as has been reached in Panama would 
cost us far less here than there, but still we are paying 
the costlier toll of preventable disease and death. 

Mr. Young. — How much does it cost to keep well in 
Panama ? 

Mr. Ross. — Three and four-tenths cents a day per 
man. This includes not only sanitation but medical and 
hospital treatment. The sanitation alone costs only nine 
mills per day. 

Mr. Young. — This seems a sursprisingly small outlay 
for the miracle that has been wrought in that notorious 
pest-hole. 

Mr. Ross. — It surely does ; and yet, if the people of 
the United States were to spend their public money on 
their own health at the same rate that they do on the 
health of their ditch diggers in Panama, they would spend 
$1,100,000,000 a year — more than Congress has ever ap- 
propriated for all other national purposes combined. 



THE COST OF DISEASE 319 

Mr. Martin. — Mr. Ross's total looks pretty large, 
however innocent the rate per man per day appears. 
Would not the Panama rate applied in this country put 
the nation out of business? We can stand the extrava- 
gance of keeping well a handful of 35,000 people in 
Panama for a short time, but a proportionate health bill 
for each of our 90,000,000 people — would it not be 
ruinous ? 

Mr. Ross. — A nation that can spend $1,500,000,000 on 
its tobacco ought to be able to meet a health bill of 
$1,100,000,000. Indeed if this amount, enormous as it 
is, were necessary to save us from our preventable dis- 
eases, we should actually make a profit on the outlay. 
By the most conservative estimates, the annual loss to our 
citizens through preventable diseases and death is 
$1,500,000,000.* That amounts to $29,000,000 more than 
the sum in question, and, incidentally, to about one hun- 
dred times as much as Congress has ever appropriated for 
the protection and promotion of public health. In 191 1 
the federal government spent a little less than $15,000,000 
for this purpose ; and considerably more than half of 
this went for maintaining health in the army and navy 
alone. It took almost $9,000,000 to guard the health of 
150,000 soldiers and sailors, which left less than $6,000,- 
000 for promoting the health of our remaining ninety 
million citizens. t 

Mr. Martin. — Aren't the states and counties and mu- 
nicipalities supposed to look largely after the health of 
their own citizens? The federal government can't do 
everything. 

Mr. Ross. — To be sure. The states and cities are 

* Fisher. Report on National Vitality. 

t The Need for a National Budget. House of Rep. 62 Con- 
gress, Doc. No. 854. 



320 HEALTH AND THE SCHOOL 

spending more or less — principally less — for health con- 
servation ; but in spite of that the entire expenditure — 
federal, state, county, municipal — falls enormously short 
of our need. 

Mr. Martin. — What is the extent of our need? 

Mr. Ross. — That cannot be exactly estimated with our 
present information; but it is safe to say that it would 
fall well under the requirement in Panama. The chief 
expense in Panama is for protection against tropical in- 
fections, from which a great part of our country is free. 
Relieved of that great initial expense, we have it in our 
power here, at far less expense than has been incurred 
in Panama, to lower the death rate and extend the span 
of human life beyond any points which have yet been 
reached in any country. Let me show how this can be 
done by citing a few results that have already been ac- 
complished, both in disease prevention and the postpone- 
ment of death by an enforcement of scientific treatment 
for disease. 

The control and prevention of the world plagues fur- 
nish overwhelming evidence of the economy of the gen- 
eral policy of prevention. Before vaccination against 
smallpox was introduced, 95 people out of every 100 took 
the disease, and the disease took a greater share of the 
population than any other cause of death. A community 
even now occasionally gets a taste of how it was in the 
good old days before medical freedom was so curtailed 
as to require reluctant citizens to undergo the vaccina- 
tion ordeal. In Philadelphia, in 1891-2, laxity in the 
prevention of smallpox gave a start tO' an epidemic 
which cost the city between twenty-one and twenty-two 
million dollars. The outbreak could have been pre- 
vented entirely by vaccinating all the citizens, and while 
this was being done, establishing a well-equipped disin- 



THE COST OF DISEASE 321 

fecting station, and instructing the public fully in meth- 
ods of preventing the disease from spreading. The cost 
of these measures would have been under $750,000, as 
opposed to the net loss of $21,000,000 which the city- 
suffered. 

Mr. Martin. — How was the amount of loss figured 
out? 

Mr. Ross. — A careful estimate was made of the ex- 
penses from sickness and burial, loss of time from em- 
ployment, and loss to business and transportation com- 
panies due to the epidemic. 

Dr. Latta. — We need not go so far back as 1891 for 
a smallpox lesson. Pennsylvania gave us another in 
the summer of 1912. An epidemic broke out in several 
towns and cities, and was checked only by prompt and 
wholesale vaccinations in which the state department of 
health took a hand. 

Mr. Ross. — For a most complete demonstration of 
smallpox prevention we must turn from our own en- 
lightened land to the Philippines. The health measures 
that have been carried out over there have added one 
of the most brilliant chapters to the history of disease 
prevention in the world. In seven provinces around 
Manila the number of cases of smallpox formerly aver- 
aged annually 25,000 to 30,000, of which 6,000 were 
fatal. In the year following the vaccination of the en- 
tire population of these provinces, there was not a single 
death from smallpox. In fact, no case of smallpox has 
ever developed anywhere in the Philippines or anywhere 
else in the world in an individual who has had a success- 
ful vaccination ; that is, one that has "taken" within a 
year. The money cost of preventing smallpox by vacci- 
nation is so small as to be altogether negligible in com- 
parison with the cost of the disease. 



322 HEALTH AND THE SCHOOL 

Mr. Young. — Is not the cost of vaccination in health 
and even hfe rather heavy, however? 

Mr. Ross. — We hear tales of horror told about infec- 
tion from vaccination, but such calamities, which now are 
extremely rare, must be laid to the charge of incompetent 
laboratory workers or physicians. In the Philippines, 
under skilful government supervision, not one person out 
of the 5,000,000 who have been vaccinated was ever 
authoritatively found to have died as a result. 

Yellow fever is another costly scourge which has 
been removed from our country at a comparatively 
small outlay. An epidemic of this disease in 1878 cost 
our Southern cities $100,000,000. Since 1898 yellow 
fever has been under control, and the annual saving 
from that time on. General Leonard Wood declares, has 
been a sum greater than the entire cost of the Cuban 
war, which was responsible for the investigation of the 
disease. 

Asiatic cholera and bubonic plague, the most terrible 
scourges that ever visit mankind, still take their mil- 
lions, but not from us. An epidemic of cholera in Japan 
in 1886 cost that country 100,000 lives, the money loss 
being not less than $200,000,000. The same disease in 
1892 took 8,000 lives in the German city of Hamburg, 
and cost the city $25,000,000. Bubonic plague never 
fails to take its annual toll in the Far East ; from time 
to time breaking into violent activity and stretching out 
its black hand for a hundred thousand or more victims. 

That such conditions do not exist in all parts of our 
country to-day is due to the effective vigilance of our 
Public Health and Marine Hospital Service, which has 
developed some forms of epidemic prevention to a very 
perfect degree. The country has at times had its touch 
of all the plagues. Cholera was with us 75 years ago, 



THE COST OF DISEASE 323 

and left a hideous trail. Bubonic plague gained entrance 
to the Pacific Coast in 1899, and after smoldering eight 
years, broke out afresh in 1907, and speedily began to 
spread over California. With an outlay of $250,000 
and some state aid, the Federal Government checked for 
the time what threatened to be the most deadly invasion 
a nation could possibly suffer. 

Typhoid fever, another genuine plague, has always 
been the most formidable enemy in every war. As late 
as 1898, in the Cuban war, it caused 86.24 per cent, of 
all the deaths in the army ; there being 20,738 cases with 
1,580 deaths among 108,000 men. Since then the terror 
of typhoid in war has been completely abolished by 
typhoid vaccination, which results in immunity as un- 
failing as that from smallpox vaccination. 

In the mobilization of our troops on the Mexican bor- 
der, in 191 1, the soldiers were inoculated against typhoid 
fever, with the result that not one case of typhoid was 
reported from among the entire body of soldiers. With- 
out vaccination our troops in Texas would almost cer- 
tainly have repeated the experience of the Cuban war, in 
which case they would have contracted over 4,000 cases, 
300 of them fatal. 

Dr. Latta. — Recent figures give further force to this 
Texas experience. Up to September, 191 2, not one 
death from typhoid fever has taken place in the entire 
army among the men inoculated with typhoid vaccine, 
and only eighteen cases have developed during four 
years among the sixty or seventy thousand men who have 
been immunized in that time. The navy record gives 
similar evidence. Since typhoid vaccination was en- 
forced early in 1912, not one of the 64,000 enlisted men 
has contracted the disease and at the same time the num- 
ber of cases of intestinal diseases has greatly diminished. 



324 HEALTH AND THE SCHOOL 

Mr. Ross. — The prevention of typhoid in the country 
at large has been demonstrated to he ahnost entirely in 
the sanitary regulation of the water and milk supply. 
One city after another has learned its costly lesson, in- 
stalling a million-dollar filter plant after a one or two 
million dollar epidemic, and instituting an inspection of 
its milk supply after some fatal experience with an un- 
watched and infected dairy. The effect of purifying a 
polluted water supply can be calculated with amazing 
precision; the result on the average being a reduction 
of the typhoid death rate from 62 to 17 per 100,000. 
In Munich the change to wholesome water lowered the 
typhoid mortality 97 per cent. In Lawrence, Massa- 
chusetts, the introduction of a public water filter brought 
it down 80 per cent. 

Instances of this kind can be multiplied indefinitely, 
and yet our country, as a whole, is still typhoid-ridden; 
the disease ranking fourth in our mortality lists in the 
census year 1910, and claiming annually over 30 deaths, 
per 100,000, as against 7.6 in Germany and 6.2 deaths in 
Scotland. The number of preventable deaths from ty- 
phoid in the United States every year averages 30,000, 
the number of preventable cases 300,000, and the amount 
of preventable money loss $150,000,000. 

It has been carefully estimated that the cost of pre- 
ventable typhoid for ten years would provide a safe and 
permanent water supply and inspection system for every 
community in the country. The economy that would be 
effected by making such a provision would be enhanced 
several fold from the fact that for each life saved from 
typhoid two or three lives would be saved from other 
diseases. 

Mr. Martin. — How is that? 

Dr, Latta, — When we rid our water and milk and 



THE COST OF DISEASE 325 

the rest of our food of typhoid germs, we rid them of 
most other disease germs. Various intestinal diseases 
and often contagious diseases, as well, are prevented 
by a purification of the food and water supply. 

Miss Parsons. — A very effective method of impress- 
ing communities with the economic value of suppressing 
typhoid is to sue them for damages when the disease has 
been caused through their neglect. A most important 
decision on such a case was handed down by the Supreme 
Court of Minnesota not long ago. The court ruled that 
a town is legally responsible for the death of any person 
from typhoid which can be traced to the negligence of 
the town with respect to its water supply. 

Mr. Ross. — The country would soon be rid of typhoid 
if all the courts were to follow the excellent example of 
this Minnesota court. To continue now with a few more 
instances of successful war on disease, diphtheria is an- 
other scourge which formerly was the terror of parents, 
sometimes taking the life of every child in a family. 
There was no protection against its approach and no 
measure for checking its course after the attack. Anti- 
toxin has now robbed it of its terror and, moreover, 
furnished a means for preventing its spread. A careful 
estimate of the money saving to the country from the 
control of diphtheria through antitoxin, places the an- 
nual amount not far from $100,000,000. The saving in 
money, great as it is, seems insignificant compared with 
the saving from grief and family desolation which the 
disease formerly caused ; but to-night we are discussing 
dollars, and we will not dwell on the emotional side of 
death and disease. 

There are many other diseases whose expensive rav- 
ages have been checked by scientific prevention and 
treatment — malaria, meningitis, tetanus, hook worm, and 



326 HEALTH AND THE SCHOOL 

all the forms of blood infection which were the inevita- 
ble result of wounds and surgical operations before the 
days of aseptic surgery. I shall take the time to men- 
tion only one more disease whose partial prevention has 
already saved us much, and whose extinction would 
save us more than the extinction of all the other diseases 
put together. 

Tuberculosis is still the greatest single man-killer in 
the world, being responsible for lo to ii per cent, of 
all deaths the world over, notwithstanding the fact that, 
since 1850, preventive measures have lowered the death 
rate from tuberculosis 40 per cent. This disease, which 
constantly claims 1,000,000 sufferers in the United 
States, costs us $1,235,000,000 a year, according to Pro- 
fessor Fisher, and it is gradually becoming plain to us 
that to spend a few million dollars a year in suppressing 
it is no extravagance. In fact, the year 1912 set a new 
record for expenditure in fighting the white plague. The 
total outlay was $19,000,000, of which $12,000,000 was 
public money. 

A few progressive states are venturing to spend very 
liberally for the purpose of checking tuberculosis, and 
they are making a handsome profit on their expenditures. 
New York State alone in 1912 spent over $5,000,000. In 
1907, Pennsylvania made a half-million-dollar annual ap- 
propriation, and in 1909 increased it to a million. She 
immediately reaped the benefit, her death rate from tu- 
berculosis falling in four years from 134 to 120 per 100,- 
000. That means a saving to the state of 1,000 lives a 
year and $1,600,000 in money, the net profit being $600,- 
000. Connecticut is also discovering the financial advan- 
tage of saving her consumptives. Let me quote from 
Prof. Irving Fisher : 

In speaking of the state sanatorium he says, "The 



THE COST OF DISEASE 327 

$200,000 expended in this work has resulted in restoring 
so much working power that already those discharged 
from the institution have earned $300,000. Figuring on 
this basis, the discharged patients will in three years earn 
nearly $2,000,000, thereby paying the community 900 per 
cent, on the $200,000 invested." 

Dr. Latta. — While it is true that the sanatoria in 
Pennsylvania and Connecticut, and other states as well, 
are yielding fine returns on the money invested, not only 
in restoring health to tuberculosis victims but in pre- 
venting advanced cases from infecting other people, I 
should like to suggest that merely segregating and 
treating tuberculous patients is never going to put a 
stop to the disease. Look at the annual production of 
tuberculous cases that is still going on by reason of poor 
living conditions and overwork ! Tuberculosis is a social 
disease as fundamentally as are the diseases of vice which 
usually go under that name. To exterminate it requires 
not so much a direct outlay of money on the disease as a 
far-reaching redistribution of money by which the world's 
workers will be able to buy for themselves and their chil- 
dren as much sunlight, fresh air, nourishing food, rec- 
reation, and rest as they need in order to keep well. Do 
you know the secret of the Pamana canal zone as a 
health resort? Next to destroying the mosquito, the 
main procedure has been to provide the workers with 
sanitary houses, nourishing, tempting, and abundant 
food, and plenty of opportunity to play games in the 
open air. If our people in the United States could live 
under such wholesome conditions as are now being pro- 
vided for the Panama laborers, our tuberculosis incubus 
would be lifted in less than a generation. If our general 
health is good most of us can handle a few tuberculosis 
germs without harm. Every one of us is probably carry- 



328 HEALTH AND THE SCHOOL 

ing a few of these germs about with him at this mo- 
ment; but owing either to a lowered virulence of these 
particular germs, or to a specially strong resistance on 
our part, we are not really infected, or else so mildly 
infected as not materialy to affect our general health. 
It is only when our bodily resistance is lowered, through 
fatigue, poor food, or bad air, that the germs become ac- 
tive. They can't do much to vigorous persons. 

Mr. Martin. — While we are giving the smoke a 
chance to settle after Dr. Latta's astonishing statements, 
I should like to ask how all this cost of disease and 
death is figured out. How is it possible to calculate the 
value of a man's life in money? Mr. Ross's figures have 
all been most edifying, but I don't quite understand 
them. We must all die some time. The community 
can't keep us indefinitely. Why does it cost more to 
lose us to-day than to-morrow? 

Mr. Ross. — Because we go without doing to-day's 
work. A man in his prime is a double loss because his 
labor enriches not only himself but others. A child has 
an economic value, too, on account of his future earn- 
ing capacity and the amount already invested in his nur- 
ture and education. It is only those decrepit with age, or 
the really idle, who can be spared without an actual 
money loss to society. The life values have been worked 
out carefully by experts. A child under five years aver- 
ages $1,500 in money value; a youth from fifteen to 
twenty years, $3,000; and a person from twenty to 
thirty-five years old, $7,500. After thirty-five the money 
value of an individual diminishes gradually until, at 
sixty-five, it once more reaches that of the five-year-old 
child. 

Mr. Martin. — May I ask how Professor Fisher's 
astounding figures regarding tuberculosis are reached? 



THE COST OF DISEASE 329 

Mr. Ross. — Professor Fisher bases his estimates on 
the loss of wages of the sick, the cost of treatment, and 
the capitalization of the earnings cut off by death. 

Mr. Young. — I have seen his estimates discounted 
about one-third because he fails to subtract the future 
cost of support for those whose future earnings he 
computes. Is the objection valid? 

Mr. Ross. — The objection is far from valid. It is 
founded upon a curious fallacy which discriminates 
against the dead man as having been useful to society 
merely to the extent to which he contributed money to 
the support of others. Certainly if he added to the 
wealth of society by supporting others, so did he by 
supporting himself. The work he did in the world, 
whether for his own living or his family's, was all valu- 
able ; otherwise he would not have been paid for it. 
Moreover, the farmer and the grocer and all the rest 
who profited by his purchases made their profit regard- 
less of whether he himself or his children consumed the 
goods. 

Miss Parsons. — I should like to quote Prof. Patten 
on this point. He says : "It is moderate to assert that 
a family which earns $500 a year for itself will add an 
equal sum to the classes above it. Sickness, death, or 
loss of employment means spiritual and physical misery 
in a laborer's family, as well as loss of income to the 
other classes." With respect to where the chief burden 
should fall. Professor Patten adds : "The family dis- 
rupted by such disasters cannot bear the cost of pre- 
venting them. Only the classes whose incomes enlarge 
proportionately with the growth of population can or 
ought to pay the costs. Surely, if society is richer by 
$500, through the activity of a family, it is not too much 
to say that one-tenth of the sum should be spent to 



330 HEALTH AND THE SCHOOL 

keep it in good health. One-tenth is not high replace- 
ment cost for fixed capital ; cannot society pay as much 
to replace one generation with another, which shall sur- 
pass it in body and mind as the new tool and building 
surpass the old in excellence ?" * 

Mr. Ross. — The whole question of estimating the cost 
of sickness and death, and placing the burden at the 
proper point, opens up a series of most interesting 
economic considerations, which we have no time this 
evening to follow, but for the present we are not likely 
to be led astray in accepting the estimates of such trust- 
worthy scholars as Professor Patten and Professor 
Fisher, the latter being our leading authority on all that 
relates to the economics of disease prevention. 

Let us see now in what direction this evening's dis- 
cussion has been pointing, and what bearing it has on 
our school children's health. As we have reviewed the 
various recent victories over disease, we have been pow- 
erfully impressed with one central fact, the amazing 
economy which lies in the policy of disease prevention. 
The cases we have cited applied to but a fraction of 
the diseases and ailments which afflict mankind, but even 
these few examples have left us in no doubt as to the in- 
estimable saving to the human race in wealth, strength, 
comfort, and happiness which every step in the attain- 
ment of health insures. The particular conquests of 
disease which we have mentioned merely indicate what 
may further be accomplished by applying to the numer- 
ous but neglected, every-day diseases such scientific 
methods of prevention as have already been applied to 
the melodramatic diseases, such as smallpox and plague. 
Whooping-cough kills 10,000 children a year in our 
country — far more than smallpox does, and injures all 

* The New Basis of Civilisation. 



THE COST OF DISEASE 331 

who have it. Measles takes the lives of 13,000 children — 
more than die of any other infectious disease. Pneu- 
monia is fatal to almost as many as tuberculosis, but no 
pneumonia crusade has as yet been organized. Summer 
complaint takes such a harvest of babies each year that 
were this disease accounted contagious we should be 
thrown into a worse panic over the number of its victims 
than we are over occasional small outbreaks of infantile 
paralysis or meningitis. 

Evidently the science of disease prevention has not 
more than made a start. Its chief victories, great as 
they have been, have, in the main, been limited to those 
scored through the study and the subjection of disease 
germs. Though there is still much more brilliant work 
of this sort waiting to be done, microbe hunting, the 
experts tell me, is not the final means by which to com- 
plete the conquest of disease. 

The microbe is being withdrawn from the spotlight 
in favor of the human constitution, on which the health 
conservationists are already centering their attention. 
The institution most favorable for their efforts is the 
school, and it seems, therefore, beyond a doubt that the 
next great chapter in the history of health conservation 
is to be written in our schools. In the details of school 
health work I confess to be out of my depth. I have 
accordingly asked Dr. Latta to show us how it pays to 
spend public money on the health of school children. 

Dr. Latta. — It is not possible to quote such over- 
whelming figures in connection with the health super- 
vision of school children as have been brought forward 
in Mr, Ross's report, for our fight in the schools, as Mr. 
Ross intimated, is not chiefly against decimating diseases. 
It is rather against the low state of vitality so common 
Among school children, which is due to early preventable 



332 HEALTH AND THE SCHOOL 

illnesses, removable physical defects, and unwholesome 
environment, and which makes children easy victims to 
innumerable diseases. To build up the vigor of children 
is our chief aim in the schools. Most of the virulent 
contagious diseases are already under control, but there 
are a score of diseases, both infectious and non-infec- 
tious, against which there is as yet but one known pro- 
tection. This protection lies in the high resisting power 
of a robust constitution, which can be secured only by 
means of wholesome living conditions. Tuberculosis and 
pneumonia germs and most other disease germs can make 
little headway in a body which is free from chronic de- 
fects and which enjoys the protection of good air good 
food, proper exercise, and sufficient rest. 

It is such immunity, derived from carefully developed 
strong constitutions, the most reliable and lasting of 
all immunities, that we must secure for the growing 
generation ; and it is through the schools, both public 
and private, that we can best go about securing it. No 
health crusade that has ever been undertaken can vie 
in results with what may be done for our national 
health through this means. In the schools the health 
and development of all the people can, for a period of 
at least seven years, be made subject to scientific con- 
trol ; and the education indispensable for sanitary living 
acquired. It is also through the schools that the parents 
can best be reached and instructed in matters of health. 

To raise the question whether such health supervision 
and health training are paying propositions is like ask- 
ing whether it pays Holland to keep her dikes in repair. 
The material profit that results in transforming an 
anemic child into a robust one may not appear at all 
in the financial report of the school board, but it is none 
the less evident that the community will eventually be 



THE COST OF DISEASE 333 

the richer for having a healthy, well-educated man or 
woman instead of an invalid on its hands, or possibly 
a premature tenant in the cemetery. 

Miss Parsons. — Theodore Roosevelt, whose vitality 
and endurance are the wonder of three continents to-day, 
was a child so frail that it seemed doubtful whether he 
would live long enough to enter upon any career of use- 
fulness. Attendance at the schools of his boyhood 
proved out of the question for him, and had not his 
parents wisely concluded that the course for his best 
development lay in his following his own healthful out- 
door instincts, it is highly probable that his name would 
never have appeared among those of the world's great 
men. 

Dr. Latta. — Most parents lack the wisdom or the 
means to meet the special needs of a frail child as the 
Roosevelt parents did, and it is only through the active 
cooperation of the school that such needs can ordinarily 
be met. The cost of such school cooperation is low, 
al)surdly low, compared with the amounts we spend in 
filling children's heads with curious forms of arithmetic 
and exceptions to rules of grammar. It would take but 
a slight improvement in the physical welfare of school 
children to justify the very moderate expense which 
even our most liberal systems of health supervision en- 
tail. In this connection let me quote from a report by 
Dr. Josephine Baker, Director of Child Hygiene in New 
York City : 

"This work in the schools with its control of the contagious 
disease situation, with the eHmination of the school as the 
jnain focus of infection ; the physical examination of each child 
as soon as it enters school, before it is allowed to graduate, 
and as nearh^ as possible every two years in the interim, the 
instruction of the parents in the character of defects found, 
23 



334 HEALTH AND THE SCHOOL 

and in the necessity for treatment, and the follow-up work 
necessary to induce parents to provide treatment or to record 
their absolute refusal to do so, was performed during 191 1 at 
a per capita cost of 43 cents. During this same year the per 
capita cost of the year's schooling in the public schools of New 
York City was $43.90." 

Though the amount that New York spent on the 
health of her school children was but i per cent, of 
what she spent for their "schooling-," her outlay was 
more lavish than that of any other American city ex- 
cept Montclair, New Jersey, which, for progressive at- 
tainments, is in a class by itself. 

It is not necessary to take on faith all the profit that 
lies in the health supervision of school children. New 
York has already made a substantial showing of gains 
in health and school attendance as the result of her 
energetic system. To quote again from Dr. Baker: 

"The necessary exclusions of children suffering from con- 
tagious eye and skin diseases have been reduced from 57,000 
in 1903 to slightly over 3,000 in 191 1. * * * There has been 
a definite decrease in the percentage of the number of individ- 
ual defects found each year, with the exception of defective 
teeth. Defective vision has decreased from 13 per cent, in 
1909 to 10 per cent, in 191 1; defective nasal breathing from 18 
per cent, to 11 per cent., while hypertrophied tonsils show a 
decrease from 22 per cent, to 15 per cent, in the same space 
of time." 

In benefiting the school children directly, both in mind 
and body, by reducing the number of their physical de- 
fects, and the extent of their absence from school, 
the division of Child Hygiene is also benefiting 
the schools themselves and the taxpayers, by reducing 
the two most potent causes of retarded progress in the 
schools. At an earlier meeting we quoted the figures of 



THE COST OF DISEASE 335 

the Russell Sage Foundation showing the extent to which 
school progress was retarded by the most commonly 
found physical defects. To take only one example — 
the adenoid children, you will remember, require one 
and one-tenth years more schooling to complete eight 
grades than children without defects. Dr. Baker's 
showing of a reduction from i8 per cent, to ii per 
cent, of children suffering from this defect means that 
there are now 48,500 less adenoid children in the New 
York schools than there were two years ago. While 
we cannot assume that all of these children are com- 
pleting eight grades of school work one and one-tenth 
years sooner than they would otherwise have done, many 
of them stand a very good chance of doing so. If all 
did, their increased efficiency would save the city the 
enormous sum of $2,129,150. The actual saving that 
is being made is, undoubtedly, well over half this 
amount. 

Mr. Martin. — I don't quite see why these children 
should not all make normal progress if the cause of 
their retardation has been removed. 

Dr. Latta. — Some of them doubtless have other re- 
tarding defects — notably defective teeth — still uncor- 
rected ; while others may have suffered the retarding 
influence of adenoids through several grades before be- 
ing successfully treated. Others, yet, will drop out of 
school before going through the whole elementary 
course. In spite of these considerations, the money sav- 
ing in a school system through the effective treatment, 
or — what is infinitely better — the prevention of physical 
defects, is evidently very great. 

Mr. Ross. — The question of whether money is saved 
through such means was put to a practical test a short 
time ago in Hoboken, New Jersey, where it was esti- 



336 HEALTH AND THE SCHOOL 

mated that if one school nurse saved only 40 children 
from non-promotion she would save in money an amount 
equal to her entire year's salary. The school board, after 
observing the work of a nurse whose services had been 
donated to the schools for six months, was convinced 
that her work more than compensated for her cost and 
they promptly secured an appropriation for securing her 
continued services. 

Miss Parsons. — We have heard this evening most 
illuminating facts concerning the cost of disease and 
the saving to be accomplished by preventing it. We 
have also heard something, though far less, concerning 
the cost of health. Our scanty knowledge on this sub- 
ject is doubtless due to the fact that we invest so little 
in health. Our yearly investments in preventable disease 
and death, on the other hand, are too colossal to escape 
our attention. We indulge ourselves annually in two 
hundred and twelve million dollars' worth of typhoid 
which an outlay of sixty-two million dollars would pre- 
vent, in spite of the fact that no one would take the 
disease as a gift. We fill our asylums and institutions 
with feeble-minded, blind, deaf-mute, delinquent, and 
dependent children, at a cost of many millions, never 
stopping to inquire how much less it might cost to pre- 
vent the birth of defective children, or to dO' away with 
the damaging environment and diseases which make 
normal children defective or dependent. 

Dr. Latta. — In this connection let me quote an esti- 
mate recently made. by a well-known health officer in an 
eastern city. This man estimates that an effective health 
service which shall watch over the health of the entire 
community and guard each child, from the time of his 
parents' marriage to his own, can be carried on at an an- 
nual per capita cost of 35 cents. The keynote of this 



THE COST OF DISEASE 337 

service would be health instruction. The direct result 
would be an overwhelming decrease in child mortality 
and sickness, and in defects resulting from tainted in- 
heritance or early disease. The indirect results would 
be a proportionate decrease in delinquency, inefficiency, 
insanity, crime, and poverty. 

Miss Parsons. — For 35 cents a year ! Our defectives 
needing institutional care, who alone comprise 3 to 4 per 
cent, of our population, lay a tax upon every member of 
the community of more than a dollar a year. Our people 
spend $100,000,000 on them. 

I\Ir. Young. — We have evidently not more than 
opened this most vital subject of the profit to be de- 
rived from health investments ; but if only those facts 
which have been brought forward to-night, together 
with their social meaning, could be impressed upon every 
American citizen, as they have been impressed upon us, 
this country would be plunged into revolution ; not a 
warlike revolution, to be sure, but one far more funda- 
mental than was ever brought about by marching armies. 
The changes wrought would not be in our national 
boundaries, but in our national mind. Many of our 
present ideals as a nation, our purposes and methods, 
would have to surrender to the conquering ideal of 
social cooperation. 

As yet the preservation of our national life through 
war is the dominating idea in our national councils ; the 
dominating motive in our national expenditure. It is 
almost impossible to believe that the government in 
1912 spent almost as much for military pensions and war 
preparations and consequences as for all other functions 
of government — legislative, executive, and civil serv- 
ice added together. War, past and prospective, claimed 
about $425,000,000, leaving less than $400,000,000 for 



338 HEALTH AND THE SCHOOL 

promoting the present and future economic and indi- 
vidual welfare of the American people.* 

When we outgrow our war obsession we shall have 
practically unlimited means for securing the physical 
welfare of every citizen. Four hundred million dollars, 
set free, will go a long way toward loosening the stran- 
gling conditions that bind many of our industrious men 
and women, and an appalling number of our children. 
Indeed the day is already dawning when the conserva- 
tion of people's health will be generally recognized as 
our very greatest public concern, and be provided for 
accordingly. Some of the billions now being sunk in 
coast defence and navy destroyers will be diverted for 
health defence and germ destroyers, returning a profit 
in national vitality such as never sprang from steel or 
gunpowder. The doctrine of protection will be applied 
to health as well as to industry; and the sacred phrase, 
the "American Constitution," will have a second mean- 
ing, no less sacred, as applied to the physical stamina 
of American citizens, upon which depend more fully 
than upon any inherited document our life, liberty, and 
pursuit of happiness. 



Suggested Reading 

Bruere. The Nezv Meaning of Public Health, Harper's 

Monthly, April, 1912. 
Fisher. Economic Aspect of Lengthening Human 

Life. 

* Message of the President of the United States submitting for 
the Consideration of Congress a Budget, Senate 62nd Congress, 
3rd Session, Doc. No. 11 13. 



THE COST OF DISEASE 339 

Fisher. Report on National Vitality. — Its Waste and 

Conservation. 
Mayo. The Problem of National Health, The Outlook, 

Dec. 7, 10)12. 
American Academy of Political and Social Science. 

The Public Health Movement. March, 191 1. 



XX 

COMPULSORY HEALTH 

Mr. Young. — In reviewing the work we have done 
this year for the health of our school children, we find 
that we have been moving steadily toward a very definite 
end. The reforms we have brought about, as well as 
those which still remain to be accomplished, are all evi- 
dently part of a program which is destined to be carried 
on under a public system of compulsory health. 

Mr. Martin. — That phrase has an ugly sound to 
many people. In our recent study of systems of medi- 
cal inspection we found, in several cities, great hostility 
to the idea of public health supervision, on the ground 
that it interfered with the so-called sacred right of 
everybody to regulate his own health and that of his 
children in whatever way he pleased. I am informed 
that even in Los Angeles, which has been quoted to 
us as a pattern of enlightenment with respect to chil- 
dren's health, the advocates of individual medical rights 
are threatening to upset all the good public work that 
has been started there. I should like to hear the whole 
question of medical freedom and compulsory health 
thoroughly discussed. If there is a word that will quiet 
the clamorers who are obstructing health legislation, let 
us hear it. 

Mr. Young. — The entire controversy resolves itself 
into two questions : 

340 



COMPULSORY HEALTH 341 

1. Is private health a matter of pubHc concern? 

2. If so, to what extent is the government justified 

in protecting it? 

If the advocates of medical freedom would face these 
two questions fairly, it would not take them long to 
come to an agreement with their opponents. 

Dr. Latta. — Indeed, there is already a strong ten- 
dency for opposing medical "sects" to unite for the pur- 
pose of public health conservation. A most significant 
step was taken in June, 1912, wdien the American Insti- 
tute of Homeopathy withdrew its long-standing opposi- 
tion to the efforts of the American Medical Association to 
form a federal department of health. Their old-time 
feud forgotten, the so-called "regulars" and the homeo- 
pathists are now working shoulder to shoulder for this 
great common end. 

Mr. Young. — What reasonable man can oppose a fed- 
eral bureau of health, or, in fact, any agency that will 
truly advance the health of citizens ? To return to our 
first question — Is private health a matter of public con- 
cern? — no one can fail to see that the prosperity and 
comfort of society are altogether dependent upon the 
health and strength of its members, and that every indi- 
vidual who becomes physically incapacitated diminishes 
somewhat the community's total efficiency. As we saw at 
our last meeting, the greatest burden of sickness falls 
upon those who are well. The heaviest share of the loss 
is almost never borne by the sufferer, but by those who 
are deprived of support or service or trade through his 
sickness, or by those who are compelled to meet its cost 
with their own strength or incomes, whether through 
nursing, charitable relief, or taxation. 

Miss Parsons. — Since private sickness — and what 



342 HEALTH AND THE SCHOOL 

other kind is there? — is invariably a social calamity, pri- 
vate health is assuredly a matter of public concern. 

Dr. Latta. — No one really disputes this. The advo- 
cates of medical freedom themselves are the last per- 
sons to object to the government's making the country 
a wholesome place to live in. They agree w^ith us all 
that the government has no higher duty than to protect 
our health, whether through public sanitation or the re- 
straint of individuals whose condition or activities are 
a menace to us. 

Mr. Young. — The hitch with them does not come, 
then, on the principle of public health protection, but, 
as we indicated in our second question, on the extent 
to which such protection should go. 

Dr. Latta. — Exactly. These individuals accept very 
cheerfully the health protection afforded by such public 
measures as the quarantine of contagious diseases, the 
vaccination of other people, building and plumbing reg- 
ulations, sewage and garbage disposal systems, inspec- 
tion of milk, and purification of city water, every one of 
them compulsory health measures ; but the minute the 
government goes one step further and attempts to pro- 
tect their health, not only by restraining the conduct of 
other people but their own as well, they raise a cry of 
outrage. Their own health, though it is to be fostered 
by public care, they declare to be a private possession 
to be regulated as they see fit. 

If the loss of such people's health injured no one but 
themselves, we should not be inclined to quarrel with 
their view. Unfortunately, however, their children's 
adenoids, which they refuse to have treated or removed, 
are a distinct obstacle to social progress. The death of 
their children from diphtheria, which the use of anti- 
toxin would have prevented, is a serious loss to the 



COMPULSORY HEALTH 343 

community. Their evasion of vaccination not only 
means the HkeHhood that their usefulness to society will 
be crippled or extinguished by an attack of smallpox, 
but that they will infect others who have also disre- 
garded the obligation of every one to cooperate, by 
means of vaccination, in keeping the community free 
from the plague. These are but a few of the many in- 
stances in which individual medical freedom is not com- 
patible with the general good. 

Mr. Martin. — But you couldn't get the advocates of 
medical freedom to admit that harm comes of their 
practices. They hold that their methods of handling 
disease are as good as any, and they denounce the least 
interference in this matter as a violation of the right of 
every one to select his own medical advisor. They de- 
clare that it is an inalienable human right to enjoy 
a sort of three-in-one form of liberty — political, re- 
ligious, and medical. How is one to meet such an argu- 
ment? 

Mr. Young. — By trying to clear up the extraordinary 
confusion of mind from which it proceeds. 

In the first place, there are no such things as inalien- 
able human rights ; and, in the second, there is not the 
slightest analogy between so-called medical freedom and 
political or religious freedom, as the word freedom in 
the two cases refers to two distinct things. 

"Rights" are not born with individuals, as is so com- 
monly assumed, but conferred upon them by the state 
when it becomes advantageous to do so. Political free- 
dom, for example, is a right which advanced societies 
now generally think well to bestow upon men ; but it is 
evidently neither an inalienable right nor a human right, 
or men would always have had it and so would women. 
Religious freedom is also a rather newly acquired right, 



344 HEALTH AND THE SCHOOL 

as certain fairly recent and very bloody chapters in his- 
tory attest. 

Mrs. Ross. — May I interrupt to ask just what we 
mean by political and religions freedom? 

Mr. Young. — The freedom to hold and express our 
own convictions and desires, which, taken together with 
those of others, form the basis of united action. 

Mrs. Ross. — Is that all there is to this dearly prized 
freedom ? It seems to me that we have the same liberty 
in every other department of human affairs, medicine 
as well as the rest. 

Mr. Young. — That is precisely what we have, and, 
moreover, it is the only real freedom that we can ever 
hope to have. Free conduct is impossible as long as 
the world holds more than one person. Modern society 
places no restraint upon convictions in any conceivable 
matter ; but unrestrained conduct it permits in none. For 
instance, we all have architectural freedom, in that we 
may hold and expound a theory of making gossamer 
houses, if we like ; but when we come to build we have 
to conform to the building regulations. We have educa- 
tional freedom, in that we may believe in and advocate 
the abolition of schools for children ; but when we come 
to bring up children we have to send thern to school. We 
have medical freedom, too, in that we are welcome to 
espouse any unheard-of theory of health and healing. 
But this does not satisfy the advocates of medical free- 
dom. It is conduct or nothing with them, They claim 
the right of every individual to say when, how, and by 
whom he and his children shall receive medical advice 
and treatment. 

Dr. Latta. — Or, to put it in another way, the right 
of every one to take the lives of himself and his chil- 
dren, and often his neighbors, into his own hands, 



COMPULSORY HEALTH 345 

and, though untrained in medicine, to deny the estab- 
lished truths of medical science and commit himself to 
some fantastic theory and to some misguided or un- 
scrupulous "healer," who has no more real medical 
knowledge than himself. In so far as the term medical 
freedom refers to unrestricted conduct, it is no more 
reasonable to demand it than to demand unrestrained 
action in any other branch of human affairs. One could 
as appropriately demand building freedom or schooling 
freedom or suicide freedom or a thousand other anti- 
social freedoms. 

Mr. Young. — I think our discussion has served quite 
thoroughly to lay the ghost of the inalienable-human- 
right idea. This phrase is really no more than a bit of 
outworn rhetoric left over from the French Revolution. 
The twentieth century recognizes inalienable duties, 
rather than rights, and the duty of health is not the 
least of these. That this duty should be enforced by 
the community has been made very evident to us. How 
far the enforcement should be carried is still a matter 
for debate. This is the second point on which the medi- 
cal freedom people raise their loudest outcry. 

Mr. Martin. — It seems to me they have some show 
of reason when they claim that the government is not 
justified in making any kind of treatment, such as vac- 
cination, or the inoculation of serums, or the surgical 
removal of adenoids, compulsory. So long as the value 
of a certain form of treatment is not agreed upon by 
all the "schools" of medicine, they say it is tyranny to 
enforce it. 

Dr. Latta. — What if a "school" of architecture rec- 
ommended the building of a skyscraper on a foundation 
of laths? Would it be tyranny for the government to 
interfere? The very term "school of medicine" is an 



346 HEALTH AND THE SCHOOL 

absurd relic of the days when all medicine was a guess 
in the dark, and one school's guess was as good as an- 
other. Within the last fifty years medicine has been 
developing into a science. No really scientific fact con- 
cerning hygiene or therapeutics belongs to any "school," 
and similarly no special propaganda that is limited to 
any "school of medicine" can be regarded as scientific. 

The facts that are beyond scientific dispute in pre- 
ventive medicine and therapeutics are not yet very 
numerous, but they at least have the incalculable value 
of being beyond dispute, and, unfortunately, they are far 
more numerous than any laws based upon them. The 
government is justified in enforcing measures based on 
every one of them and on no more. It is also justified 
in admitting to medical practice and to public health 
work such men as have had genuine scientific training 
and no others. 

Mr. Martin. — What are some of the scientific facts 
on which the government should take compulsory ac- 
tion? 

Dr. Latta. — Sweeping preventive measures should be 
carried out in connection with such established facts of 
hygiene and sanitation as the following: 

Overcrowding in tenements is a prolific cause of tu- 
berculosis, pneumonia and fatal infant diseases. 

Employment of mothers during child-bearing years 
endangers the health and lives of babies. 

Employment of young women in straining occupa- 
tions injures them and the next generation. 

Excessive employment of children injures them for 
life. (There are now, according to the twelfth census, 
1,750,000 children between 10 and, 15 years of age em- 
ployed in this country. The population in the previous 



COMPULSORY HEALTH 347 

twenty years had increased 50 per cent., while the num- 
ber of employed children had increased 150 per cent.) 

Certain food adulterants and disguised drugs are de- 
stroying thousands of adults and children every year. 

Pollution of the soil is the chief means of spreading 
hook-worm and other parasitic diseases. 

Pollution of the water supply is responsible for over 
half our 300,000 annual cases of typhoid fever. 

Unclean milk kills 10 per cent, of all our babies be- 
fore they are a year old. 

Feeble-mindedness, syphilis, insanity, sense defects, 
epilepsy, and alcoholic injury are hereditary. Five to 
ten per cent, of our population are born with such de- 
fects. 

These are a few of the health facts, as yet very 
scantily considered in our laws, that our progressive 
legislators must heed in framing their programs. 

Mr. Martin. — Are these facts equally sure regarding 
forms of medical treatment? 

Dr. Latta. — Yes, and some of these are of the great- 
est importance, not only for the cure, but the prevention 
of disease. Such are: 

(a) The established efficacy of certain antitoxins and 
drugs for curing and preventing certain diseases, 

(b) The modern achievement of simple and safe sur- 
gical methods for correcting various physical de- 
formities. 

(c) The dependence of sound vitality upon sound eyes 
and teeth. 

The value of antitoxins in at least two very danger- 
ous diseases is past all discussion. In both diphtheria 
and cerebrospinal meningitis the use of antitoxins has 
brought down the death rate about 75 per cent. Anti- 



348 



HEALTH AND THE SCHOOL 



toxin treatment, under careful regulation, of course, 
should be compulsory for each of these diseases. 

DIPHTHEPIA IN CHICAGO 

BEFOPE AND A FTEP ANTITOXIN 

Co^^PPlR^NG the. Avepage Death Pates of T\a(o 14-Yeab PecioDd 

BE.FOP& -1862-1895 ; AF-TEP ~ 1896-1909. 

Before m^B^DOBnB^iBaB^HBnBBmaBi^iHBMaiHHiHBHi ■» 

Thtt75i percent' reduction in llie iea^Vi rate i6 ec^ciivaUnt to a £avinq of 25,678 liva^ 
in lh« fourteen ycar6 in which diphtharia antitoxin Viaa bean u6eA 



AVERAGE MONTHLY 
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Vaccination against smallpox we have already re- 
peatedly discussed. It is so far the only known means 
of preventing the disease, and its immunizing power for 
a certain length of time is absolute. The state is justified 
in the strictest enforcement of this measure. 



COMPULSORY HEALTH 



349 



The complete prevention of eye infection at birth by 
the prompt use of silver nitrate is another matter of 
scientific certainty. Before the treatment was used, opli- 



BULLETIN CHICAGO SCHOOL OF SANITARY INSTRUCTION 

On March 4 the council passed a very important ordinance, one 
of the most important ordinances passed in a long time. 

Under it every physician and midwife must report to the Health 
Department within twenty-four hours the occurence of every case 
of sore eyes developing within seven days after birth. 

We hope we may soon be able to take the next step and supply 
the nitrate of silver drops for use in all cases in which they cannot 
otherwise be provided. 



There dxe 60,000 blind persone in the United StaCtes. 
At le^st ZO.OOO o( these sad causes 

were Prevents. bLe I 



IF CHICAGO 

WILL ENFORCE 

THE USE OF 

-THIS- 



5f 



THE 

MEDICINE 
DRPPPEfl 



IT WILL COST 
-THIS- 



F'EVEi ce:>jts 



AND 
PREVENT 

-THIS- 




•THE DROPS' 

To Lose oKe 6 SIGHT is LiKe LosiKg LIFE iraeir 

SAVE YOUR. BABYS SIGHT 



ChlCAdt, T)«B<r1t^«,.r o« H««lT<x- E<lu<.»t.,n.^l -Sane* i^..9l 






COMPULSORY HEALTH IN CHICAGO. 

A good example of popular education directed by a public health 
official. 

24 



350 HEALTH AND THE SCHOOL 

thalmia neonatorum, an eye disease of the new-born, 
caused one-quarter of all the cases of blindness. Where 
the silver nitrate treatment is enforced, as it is in New 
York City, this disease has been practically eliminated. 
The general enforcement of this treatment would save 
the eyesight of about 35,000 people in our country every 
year. 

The successful correction of various deformities, such 
as bow-legs, club-feet, and impeded tongues, formerly 
regarded as almost miraculous, is now within the tech- 
nic of every good surgeon. The paralyzing handicap 
under which every cripple lives is sufficient reason for 
the state's enforcing skillful surgical treatment in all 
cases in which the risk is slight and the chances of suc- 
cess practically certain. 

Mr. Martin. — Will parents ever agree to such arbi- 
trary measures as enforced surgical operations? 

Dr. Latta. — Not at present, certainly, but when an 
understanding of the value as well as the safety of such 
treatment has become general there will be no trouble. 

The connection between good health and sound teeth 
and eyes we have discussed at an earlier meeting. The 
state cannot afford to permit eye-strain and decayed teeth 
to leech the vitality and the efficiency of the people, 
least of all the children. There will be no difficulty in 
enforcing general mouth sanitation and proper care of 
eyes when capable public oculists and dentists are avail- 
able for all who desire their services. 

The sanitary, hygienic, and medical facts we have 
cited form part of a very conservative list of items 
which the government must heed thoroughly in develop- 
ing its program of compulsory health. They call for a 
liberal outlay of public funds, and some curtailment of 
personal liberty. The result of such action would be 



COMPULSORY HEALTH 351 

an enormous increase in the nation's wealth and an un- 
precedented personal freedom from disease. 

Mr. Young. — The matter of enforcing any kind of 
medical treatment, which Mr. Martin brought up, is evi- 
dently a very minor aspect of the entire problem of 
compulsory health which bristles with difficulties on 
every side. How the whole duty of the citizen to keep 
himself, his children, and his neighbors in good health 
may be most successfully enforced is a most complex 
question, but it is at least a beginning to recognize clearly 
that it should be enforced and to be convinced that a 
thoroughly established system of compulsory health will 
have an effect upon the nation more fundamental and 
more favorable in many ways than our boasted system 
of compulsory education now has. 

Miss Parsons. — There are many indications that the 
day is not very far away when such a system will be in 
force. Our national, state, and municipal governments 
are more and more concentrating their efforts on means 
of enforcing individual duties which justice to all re- 
quires. Among the ameliorative measures recently en- 
acted, or still under consideration, those relating to 
health, and especially the health of children, loom large. 
The health supervision of school children, which is rap- 
idly becoming general and which is beginning to include 
opportunities for free dental and medical care, is the 
most conspicuous measure which looks toward actual 
health enforcement; but this, after all, is only one of 
many which either have been or must be enacted and 
carried out to make the health of children secure. 

Dr. Latta. — The school and the home can certainly 
never cope with the problem alone. No matter how 
sanitary they may be, or how skillful the care they pro- 
vide, they cannot prevent weakness and disease from 



352 HEALTH AND THE SCHOOL 

reaching the children in a score of ways outside their 
control and sometimes even their knowledge. Contami- 
nated water and milk, adulterated food, badly ventilated 
public buildings and conveyances, unsanitary streets, and 
city smoke are evils out of the reach of mere parents 
and teachers, or even school doctors, but they injure 
children as seriously as any others in the community. 

Mr. Young. — There are also many faulty conditions 
and practices in the homes themselves which the school 
has no power to control. Poverty, bad housing condi- 
tions, excessive employment of children, and, more fun- 
damental still, the constant birth of children whose par- 
ents are suffering from transmittable diseases, defects, 
or alcoholism, are some of the factors which make the 
regulation of public health one of the most widely rami- 
fied and difficult problems that modern society has to 
solve. 

What we have been able to do for the school children 
this year is, therefore, only a beginning of what should 
be done for them, either during their school days or be- 
fore, and what, moreover, it will require the thought 
and energy of the whole community to get done. Again 
and again our efforts have been cheeked for lack of out- 
side reinforcement. We have taught the children and 
their parents the necessity of fresh air, but we have not 
been able to do away with the windowless bedrooms in 
which many of them are obliged to sleep. We have told 
the mothers how to feed their children properly, but 
many of them have not the money or the time to do it. 
We have ordered the children to keep clean, but some of 
them live two blocks from the nearest pump. We have 
instructed the older girls how to care for babies and 
impressed upon them the importance of clean milk, but 
most of the milk that is delivered to their homes isn't 



COMPULSORY HEALTH 353 

safe for a baby to swallow. We have urged the chil- 
dren to go to bed early, but many of them are still on 
the street at all hours of the night, selling papers or 
carrying messages, and there is no law to stop them. 
We have taken every step we could to prevent our school 
children from contracting defects and diseases, but we 
have had to admit to the schools a new crop of diseased 
and degenerate children which the community permits 
certain notorious and prolific families to add each year 
to our population. 

Mrs. Ross. — Do you not sometimes feel that in the 
face of all these adverse conditions the efiforts of the 
school are futile? 

Mr. Young. — Never. I mention these adverse conditions 
not at all as a ground for discouragement. It is, indeed, 
a matter for congratulation that our work for the health 
of the school children has brought them to light. While 
the school cannot hope to exert any direct control over 
such matters as proper tenement house construction, 
steady and sufficient family incomes, restricted labor for 
mothers and children, a guarded milk supply, and an 
observance of the laws of eugenics, its close touch with 
almost every family in the community makes it the most 
effective of all agencies for discovering conditions that 
are injuring children and for creating an informed and 
exacting public sentiment for correcting them. That 
these evils will in time be corrected is certain. No un- 
just and dangerous conditions can long persist when in- 
telligent attention has been directed toward them, and 
the people have been roused by a vision of better things. 

Miss Parsons. — We surely need to keep sight of the 
vision. Our hearts and our heads, too, would fail us if 
we did not now and then pause for a clear survey of 
the heights we are climbing. This evening, which closes 



354 HEALTH AND THE SCHOOL 

our year of work, is an especially happy time for such a 
pause. Before entering on a new year, let us stop for a 
glimpse ahead. What promise does the future hold for 
the health of our children? 

Dr. Latta. — Every promise. A sound physical in- 
heritance, a wholesomely spent childhood which will de- 
velop and strengthen inherited vigor, and an environ- 
ment which is free from infection. This means that 
practically every child will be well all the time, and that 
child mortality, which is now one of our national scan- 
dals, will be limited almost entirely to unavoidable acci- 
dent; in other words, that where ten of our babies and 
children now die, nine will live to grow up. 

Mr. Young. — You have surely shown us a shining 
vision, Dr. Latta. Will you not indicate briefly how it 
is to be realized? 

Dr. Latta. — First, a universal sound physical inheri- 
tance can only be reached through the practice of 
eugenics. 

Mr. Ross. — And what is that? 

Dr. Latta. — We may call it the art of being well 
born. All that pertains to securing a sound physical and 
mental inheritance for the coming members of the race 
goes under the name of eugenics. This department of 
human aspiration, or the pursuit of the superman, has 
not yet evolved into what one may call a real science, 
but it will, in due time, and eventually the people will 
heed all its mandates. In the meantime, there is enough 
for society to do in acting on the present common 
knowledge regarding the hereditary transmission of 
feeble-mind — really the root of most of our social ills — 
defective sense organs, and alcoholic injury, to say 
nothing of the effect of war in lowering the stamina of a 
people. 



COMPULSORY HEALTH 



355 



Mr. Ross. — What possible connection can there be 
between war and eugenics? 

Dr. Latta. — A most fundamental one. Our purblind 
governments pick out the very flower of their people's 
manhood to be slain in war by bullets or disease and 
leave the old, the worn out, and physically defective men 
at home to become the fathers of the next generation. 
Can you imagine a more ironic contrast between the 
alleged purpose of war, which is to strengthen a nation, 
and its actual result, which is to weaken it at the very 
core of its being? 



D 



Male 9 Female 

A=Alcoholic 

p = Feeble-Minded 

d,lnf.=Died in Infancy 



Dr^^n 



«1^ 



EIGHTEEN FEEBLE-MINDED CHILDREN AND GRANDCHILDREN. 

A feeble-minded woman married an alcoholic man. Seven of their 
children were feeble-minded, two were alcoholic, and one boy 
died in infancy. Two of the children (both feeble-minded) 
had children. All eleven were feeble-minded. Nothing is 
known of the mother of the group of six feeble-minded grand- 
children. 

[Chart prepared by the New Jersey Training School for Feeble- 
minded Children, Vineland, N. J.] 



KAKOGENICS (BREEDING OF THE UNFIT). 

Should the state assume responsibility for preventing the increase 
of feeble-mind and other defects through inheritance? 



Miss Parsons. — A few of our states are begmning to 
recognize the need of selecting sound parents for the 
next generation. Some are segregating epileptic and 



356 HEALTH AND THE SCHOOL 

feeble-minded men and women. Indiana, in 1909, took 
the advanced step of unsexing 800 degenerate men. Nine 
states can now legally unsex habitual criminals. A few 
states have recently enacted laws restricting mar- 
riage to those who have proper physical and mental 
qualifications. Washington, perhaps the most advanced 
state in this regard, requires medical certificates from 
both contracting parties, signed by a certified physician 
after due examination, certifying that they are sound 
and well in body and mind, and free from serious taint 
in their heredity. Persons prohibited from marrying are 
those affected with tuberculosis, alcoholism, epilepsy, in- 
sanity, deaf-mutism, blindness, and other serious diseases 
and defects which affect posterity. We must confess, 
however, that in no state, as yet, has the operation of 
such radical laws been very successful. 

Dr. Latta. — That is no reason for discouragement, 
however. Laws that are in advance of a popular . de- 
mand are usually dead letters. Eugenics by its very 
nature can become a controlling force only through the 
intelligent cooperation of all the people. This problem, 
like every health problem, is fundamentally one of popu- 
lar education. 

Miss Parsons. — It is interesting to note in this con- 
nection that the largest of all the exhibits at the great 
International Hygiene Congress, held in Washington in 
September, 1912, was devoted to eugenics and sex-hy- 
giene. 

Dr. Latta. — The second item in our health forecast, a 
childhood spent in wholesome work and play which will 
develop and strengthen natural vigor, has been the theme 
of our entire year's study. It is not primarily a medical 
question, and I should be glad to hear some one else 
sum up the conditions on which such a childhood depends. 



COMPULSORY HEALTH 357 

Mr. Ross. — Dr. Latta is right. It is an economic ques- 
tion. Health is a purchasable commodity. A community 
can make its children, except the ill-born ones, as healthy 
as it pleases if it will pay the bills. Nourishing food, 
pure water, good air, plenty of play and rest, and com- 
petent medical care, we are told, are all that is needed to 
keep children well. The cost of these necessities is not 
formidable, but it viiist be paid if our present heavy bur- 
den of juvenile sickness and death is to be reduced. 
Mr. Young. — Who is to pay it? 

Mr. Ross. — The cost must be divided between the 
family and the community. 

Mr. Young. — But many families haven't enough in- 
come to afiford good health. Schools and health depart- 
ments likewise can't get the necessary appropriations for 
efficient service. 

Mr. Ross. — True. Society has not yet learned to dis- 
tribute its great wealth through the channels that bring 
the best returns. It has not yet grasped the vital fact 
that to rear children properly, a family must have econo- 
mic freedom ; that a school or health department to do 
its work as well, must be as free. At the present cost of 
living, a working family having three children must have 
an income of at least $600 to $1,000, according to locality, 
to keep decent and well. A school, to be conducted prop- 
erly, requires an annual expenditure of not less than 
$30 to $40 a year on each child ; in large cities more. A 
health department, to afford effective protection for every 
member of the community, must spend on instruction, 
quarantine, nursing, and treatment at least 35 cents a 
year on every member of the community. 

When we all come to realize that the dollar value of 
the human lives in this country amounts to over $250,- 
000,000,000, whereas the total amount of physical 



358 HEALTH AND THE SCHOOL 

wealth is less than half this sum, $110,000,000,000, we 
shall conclude that it is the simplest business sense to 
give our first attention to the up-keep of the more valu- 
able national asset. The dollar value of a child be- 
tween five and fifteen years old, we have previously seen, 
is between $1,500 and $3,000. The up-keep and care of 
a motor-car of equal value might easily cost 50 per cent, 
of this amount a year. The maintenance and care of a 
child cost less ; but, notwithstanding the moderation of 
the amount, several millions of our children are failing 
to get the appropriation. When society understands the 
value of children, their present pathetic struggle for 
health and life will be won. Like the practice of eugen- 
ics, the safeguarding of children's health throughout 
childhood waits only for an educated public to de- 
mand it. 

Dr. Latta. — Our last item, an environment free from 
infection, is one which involves both the doctors and the 
laity. It means literally the eradication of all the 
"catching" diseases from the earth. 

Mrs. Ross. — I cannot see how that will ever be 
done. How can you put a stop to measles, for instance, 
when it is so often transmitted before it is recog- 
nized ? 

Dr. Latta. — At our present stage of medical knowl- 
edge I cannot say. It can, however, be checked now to 
some extent by teaching people to recognize its first 
symptoms, and to conform faithfully to quarantine regu- 
lations. To repeat, once more, it is only through a 
certain amount of medical education of all the people 
that we can ever get control of the common contagious 
diseases of childhood, unless, possibly, prophylactic se- 
rums should be developed which would render children 
immune to all of them. 



COMPULSORY HEALTH 359 



Measles in a School Is Like Fire in the Tall Grass. 

If you let the child have measles when he is young, you 
may save a doctor's bill later on, but you may have to pay 
the undertaker now. 

When grown people have "chickenpox," hang out the 
yellow flag and get vaccinated. 

It is sometimes difficult to protect a child from scarlet 
fever, but it is easier than to see a child made deaf for life. 

If the child shows the rash of scarlet fever, do not per- 
suade yourself it has chickenpox. Send for the doctor. 

A neighbor may send your baby a basket of toys ; but if 
there has been scarlet fever in that family, put the basket 
and its contents in the fire. 



POPULAR EDUCATION IN PREVENTIVE MEDICINE. 

From the Kansas Health Almanac. 



Mr. Martin. — To require our children to be vacci- 
nated for half a dozen different diseases would be about 
as bad as running the risk of their taking a few ! 

Dr. Latta. — It will probably not come to that. The 
medical and ethical education of the people is not a 
hopeless task. When every one has enough medical 
knowledge to recognize suspicious symptoms, and enough 
conscience to take the necessary steps to guard others 
from infection, the battle will be more than half won. 

Miss Parsons. — Before that time we shall have to 
have free expert medical service. 

Mr. Martin. — Why so? 

Miss Parsons. — Isn't it too much to expect the human 
conscience to urge the employment of a doctor at private 
expense for the sake of quarantining a child who may 
not seem sick enough himself to need medical care? 
Society cannot safely depend on voluntary private con- 



36o HEALTH AND THE SCHOOL 

tributions for defraying the necessary cost of discovering' 
contagious diseases. 

Dr. Latta. — There is not a better instance of how a 
free and accessible pubHc medical service would benefit 
the entire community than the one which Miss Parson? 
cites. It would be the most powerful of all factors in 
the suppression of contagious diseases. At present th^ 
epidemics get started in the poorer districts before th^ 
doctors hear of them. To avoid this it is necessary that 
good doctors and nurses be close to the people, which 
can never be while high fees keep them apart. 
: Mr. Martin. — I have been struck by the unanimity 
[with which every one of you has declared that public 
health is fundamentally a question of public education, 
not only medical, but economic and social. Now, how is 
all this popular education to be carried on ? 

Miss Parsons. — By far the most thorough and effec- 
tive way of directing it would be through a national 
department of health, whose chief business would be the 
collection and distribution of health information through- 
out the land. Just as the department of agriculture 
gives out facts concerning the best methods of raising 
crops of animals and grains, the department of health 
would give out instructions for securing the richest pos- 
sible human harvest, the value of which would exceed 
many times that of any other national output. 

Mr. Young. — Such a department, to do its most effec- 
tive work, would have to cooperate closely with the 
schools ; for, in spite of all their imperfections, they 
are our best equipped agency for carrying on public 
instruction. 

Miss Parsons. — So they are, and their influence can, 
moreover, be enormously increased. The greatest weak- 
ness of our schools as agents of instruction at present 




It.is better to exclude one child 
with a sore throat from the school 
for a few days than to close the 
school for a week and treat a 
dozen cases of diphtheria. 



The Fable of the Country School 

THERE was a certain country school teacher who was so busy 
that she did not read very much and did not believe that it was 
worth her while to know any new fangled ideas about how dis- 
eases are transmitted. One day a pupil in her school complained of 
a sore throat; the next day the teacher heard that the child had diph- 
theria. Several more children complained of sore throat and in a few 
days there were more cases of diphtheria. So the health ofl&cer closed 
the school and it remained closed six weeks. The teacher suffered 
much from the loss of salary and the children missed much schooling 
that they needed. 

Next year a new teacher came to the school. She believed that 
healthy children are easier to teach and to handle than sickly ones, 
so she set about making the school healthy. She found that the children 
had all been using one common drinking cup, which they dipped into the 
water bucket and then drank from. In this way they made it perfectly 
certain that if any child had any contagious disease all of them would 
have a chance to get it. So the teacher got a water cooler and made 
each child bring a cup to school for his own use. She also ventilated 
the school and got the trustees to put the sanitary arrangements in order. 
One day a child came to school and complained of a sore throat. 
The teacher sent the child right home and got the doctor to send a 
culture from its throat to Richmond. When the State Board of Health 
said that it was diphtheria, the child was quarantined. But none of 
the other children caught the disease and the school kept right on. 
Whereat the teacher believed even more firmly that disease is pre- 
ventable if you know how. 

Moral : Real Knowledge is a Handy Thing to Have around the School. 



HEALTH ADVERTISING. 

Health Commissioner Williams of Virginia recognizes the universal appeal of 
pictures and stories. This one page from the Virgmia Health Almanac 
is worth a volume of abstract argument in educating a community to demand 
health supervision in schools. 



362 HEALTH AND THE SCHOOL 

is that their efforts are confined almost entirely to little 
children. Ninety-three per cent, of all the nation's chil- 
dren never go beyond the grammar school, and half of 
these don't get through it. 

Mr. Ross. — Is that possible? How much practical 
knowledge, medical, economic, and social, are such little 
youngsters able to carry away with them? 

Mr. Young. — That is a fair question. We are very 
liberal with the canned knowledge we offer them — to be 
opened on some future day when they are parents and 
householders and voters, and their little cans are either stale 
or lost. Knowledge, to be of much service, has to be fresh 
when it is used, and, as Miss Parsons intimated, our 
schools must devise means of serving it fresh to all the 
people when they need it, not only the children, but the 
parents who are bringing up children, the voters who are 
trying to run the government. We shall have to grow 
out of the notion that the work of education is over for 
the children who are no longer formally enrolled in 
school classes. The school must learn to hold right on 
to those children by means of clubs, continuation classes, 
lectures, exhibits, entertainments, and publications ; so 
that the children, as they grow older, will still regard 
the school as a center of vital instruction and inspiration. 

Miss Parsons. — Our wide-awake communities have al- 
ready grasped this broader importance of the school. 
Many cities and country districts are uniting the school 
and the home by means of teacher nurses. Many are 
using their school houses most successfully as social cen- 
ters. In Texas the movement to enlarge the educational 
influence of the school has become state wide, and a state 
architect is employed to supply free plans to all communi- 
ties that wish their schools equipped for general educa- 
tional and social purposes; and practically all the com- 



COMPULSORY HEALTH 363 

munities that are building or remodeling their schools 
wish to have them so. 

Mr. Martin. — The Texas schools are an encouraging 
approach toward the ideal school for which we have all 
been striving. Let us take a moment to picture this 
school. Our health forecast, to be complete, should in- 
clude a description of the agency which is to exercise so 
dominating an influence on the health of the people. 

Mr. Young. — The school of the future will not only 
teach but demonstrate health. This means that the 
school houses and their surroundings will in time reach 
sanitary perfection, and that commodious and well-ap- 
pointed playgrounds, gymnasia, swimming pools and 
lunch-rooms will be provided for 100 per cent, of our 
children. 

Dr. Latta. — It means also that the school will follow 
a positive program of health development for its children, 
all of whom will be under its supervision from birth. 
It is, indeed, in the years preceding school age that the 
need of public health supervision is greatest. At present 
one child in every five dies before he is a year old ; and 
one child in every three or four before the age of six. 
The rame diseases, moreover, which take these literally 
uncounted lives weaken and maim hundred of thousands 
of children who survive their attacks. The school must 
accordingly reach out to the homes, instruct parents even 
before their babies are born, and then guard the new ar- 
rivals against the havoc-working diseases which now 
make a terror of the first five years of childhood and fill 
our primary grades with defective children and our ceme- 
teries with small-sized graves. 

Among its enrolled children the school will not only 
build up the weakling and treat the defects that it could 
not prevent, but it will develop the health of those chil- 



364 HEALTH AND THE SCHOOL 

dren who are well, and strengthen those who are already 
strong. It will aim to bring every pupil to his maximum 
pitch in physical strength and endurance no less than in 
mental vigor. While the school of the future must have 
its practicing doctors, surgeons, and dentists, and their 
nurse assistants always available to give treatment, as 
well as accommodations and appliances for medical, 
dental, orthopedic, and simple surgical treatment, its 
most conspicuous health service will be in the develop- 
ment of hygiene and physical education. The greater 
the number of hygienists, the smaller the number of 
physicians who will be required to give their time to 
treatment. Similarly, the greater the area devoted to 
well-used playgrounds, gymnasia, and swimming pools, 
the less space need there be for dispensaries and operat- 
ing rooms. 

Miss Parsons. — One further word as to health educa- 
tion. We have just seen how the educational influence 
of the school is being extended. In addition to teaching 
the children whatever they can learn that makes for 
health, the future school will do as much for their par- 
ents. Libraries, exhibits, and museums will offer avail- 
able and graphic information on all important health 
matters. Lunch rooms and milk stations connected with 
the school will afford constant demonstrations of the 
proper selection and preparation of foods. Health 
nurses on every school staff will instruct mothers, both 
in the schools and in the homes, in the care of babies 
and children. Every process, in short, that is essential to 
keeping a family or a community well and strong will 
be clearly taught and demonstrated in the school. 

Mrs. Ross. — That will not be all. The school will not 
only teach but train. It will not only show girls and 
women the art of wholesome living, but perfect them 



COMPULSORY HEALTH 365 

in the art. Most girls become housekeepers and mothers, 
84 per cent, of whom do their own housework and cook- 
ing-. Our schoolgirls and their mothers actually hold the 
strength of the nation in their hands. The school of the 
future will see that these hands are fitted to their task. 

Mr. Martin. — In addition to carrying on instruction 
and training, each school will become to some extent an 
experiment station, setting itself to learn the health con- 
ditions and needs of its own community and to devise 
means for meeting the latter. It will thus become a 
center of information and direction which will enable 
both public and private improvement agencies to co- 
operate effectively under its direction. 

Mr. Young. — It is indeed only through such close and 
constant contact with the vital concerns of the com- 
munity and with all the members of society, adults and 
babies no less than enrolled children, that the school of 
the future will successfully educate the people in the 
principles that make for health and happiness. When 
both by precept and practice it trains all the people all 
the time to right thinking on the three fundamental 
concerns upon which our national health depends — our 
physical, economic and social welfare — the alleged con- 
summate support of our democracy, the public school, 
will become such in very truth. 

Suggested Reading 
compulsory health 

Bruere. The Nezv City Government, Chapter XL 
Gorst. Children of the Nation. 

Seager, Henry R. Social Insurance: Program of Social 
Refortn. 



366 HEALTH AND THE SCHOOL 

Warbasse. Medical Sociology: The Relation of Medi- 
cine to Society. 

eugenics 

Carnegie Laboratory for Experimental Evolution. 
Bidletins. 

Davenport, Charles B. Eugenics, the Science of Hu- 
man Improvement by Better Breeding. 
Heredity in Relation to Eugenics. 

Jordan. The Human Harvest. 

Eugenics education society. Problems in Eugenics. 



home and school improvement 

Chapin, Robert Coit. The Standard of Living among 

W orkingmen s Families in New York City. 
Perry. Wider Use of the School Plant. 
Saleeby, C. W. Parenthood and Race Culture. 
Search. The Ideal School. 



SUMMARY OF SUGGESTED READING 

The following list has been prepared for those who 
wish to study special phases of the conditions affecting 
the health of school children. These conditions include 
many that are outside the school and which must be thor- 
oughly considered in the shaping of any successful school 
health program. Much that has recently been printed on 
these subjects is necessarily unadapted to the needs of the 
general reader who ordinarily has much difficulty in find- 
ing the matter he requires. The books and articles here 
recommended have been selected on account of their ac- 
curacy, timeliness, and simple, attractive treatment. The 
accompanying comments will serve as additional guides 
to a further study of the subjects treated in this book. 

BOOKS 

Allen, William H., Civics and Health. 411 pp. $1.25. Boston: 

Ginn & Company, 1909. 
A comprehensive and constructive study of the control of health 
through community agencies, especially the public school. Illus- 
trated with photographs, tables and charts. 

Efficient Democracy. 346 pp. $1.50. New York: Dodd, 

Mead & Co., 1908. 
Shows the need of applying efficiency tests to all public business 
and suggests how to devise records and reports so as to afford 
the fact basis essential in the proper control of public service, in- 
cluding health work and education. 
Allen and Snedden, School Reports and School Efficiency. 

183 pp. $1.50. New York: The Macmillan Company, 1908. 
A critical and constructive study of educational statistics as they 
have developed in the United States. Illustrated with tables. 

367 



368 HEALTH AND THE SCHOOL 

Arnold, Felix. School and Class Management; vol. 2, Adminis- 
tration and Hygiene. 292 pp. $1.00. New York: The Mac- 
millan Company, 1910. 
A practical program of school management by one who has had 
many years of successful experience. 
Ayres, Leonard P. Open Air Schools. 171 pp. $1.32 (postpaid). 

New York : Doubleday, Page & Co., 1910. 
An account of the origin, development, and effectiveness of the 
open air school, describing the English, German, and American 
types, with definite information as to clothing, food cost, and 
administration. Illustrated. 
Bruere, Henry. The New ctiy Government. 438 pp. $1.62 

(postpaid). New York: D. Appleton & Co., 1912. 
A discussion of municipal administration embracing many con- 
structive suggestions regarding health work as well as other im- 
portant items of city responsibility. 

Bryant, Louise Stevens. School Feeding; Its History and 
Practice at Home and Abroad. 310 pp. $1.50. Philadelphia: 
J. B. Lippincott Company, 1913. 
Includes a history of the school lunch movement, a treatment 
of its present status, and studies of malnutrition ; the food needs 
of growing children, and school menus. Illustrated with photo- 
graphs, tables and diagrams. 
Carpenter, Rolla C. Heating and Ventilation of Buildings, 

562 pp. $4.00. New York: John Wiley & Sons, 1910. 
A thorough manual for architects and engineers in charge of 
heating plants. Illustrated. 

Carrington, Thomas Spees. Fresh Air and How to Use It. 
250 pp. $1.00 (postpaid). New York: National Association 
for the Study of Tuberculosis, 1913. 
Describes in a practical way the best modern devices for secur- 
ing a maximum of fresh air — window tents, roof bungalows, 
sleeping porches, clothing, bedding, loggias for country houses. 
Illustrated with plans and photographs. 

Chapin^ Robert Coit. The Standard of Living Among Work- 
ing Men's Families in New York City. 388 pp. $2.00 
(postpaid). New York: Charities Publication Committee, 
1909. 
An accurate and comprehensive study of the actual cost of living 
among working men's families ; including a thorough discussion 
of the cost and selection of food. 



SUMMARY OF SUGGESTED READING 369 

Davenport, Charles B. Eugenics, the Science of Human Im- 
provement by Better Breeding. 35 pp. 50 cents. New York: 
Henry Holt & Co., 191 1. 

Heredity in Relation to Eugenics. 298 pp. $2.00. New 
York: Henry Holt & Co., 191 1. 
The most comprehensive and important collection of facts re- 
lating to eugenics yet published in this country. 
Denison, Elsa. Helping School Children. 352 pp. $1.55 (post- 
paid). New York: Harper & Brothers, 1912. 
A practical guide for individuals and organizations seeking to 
better the condition of children in school ; based upon work 
already done in 400 cities and towns. Illustrated. 
Dawson, W. Harbutt. Social Insurance in Germany, 1883-1911. 

283 pp. $2.00. New York: Charles Scribner's Sons, 1912. 
An account of the history, operation, and results of German na- 
tional insurance and a comparison with the National Insurance 
Act of 191 1. 

GoRST, Sir John E. Children of the Nation: Hozv Their Health 
and Vigor Should Be Promoted by the State. 297 pp. $2.50. 
New York : E. P. Dutton & Co., 1907. 
A vigorous and instructive discussion of the obligation which 
the state owes to itself as well as to the children to guard the 
latter's health. 
Green, Louise M. Among School Gardens. 388 pp. $1.25. 

New York: Charities Publication Committee, 1910. 
A thorough discussion of the place of gardening in a school cur- 
riculum, together with detailed directions for developing school 
gardens — selection and cost of equipment, planning, planting, 
care of gardens, and the harvesting of crops. Illustrated. 
Grice, Mary V. Home and School United in Widening Circles 
of Inspiration and Service. 154 pp. 60 cents. Philadelphia: 
Christopher Sower & Co., 1909. 
A working plan for cooperation between parents and teachers in 
promoting the welfare of school children; presented by a success- 
ful leader in such work. 
GuLicK, Luther H. The Efficient Life. 195 pp. $1.20. New 

York: Doubleday, Page & Co., 1907. 
Outlines in vivid form the habits on which good health depends 
and gives practical suggestions for cultivating them. 

The Healthful Art of Dancing. 273 pp. $1.54 (postpaid). 
New York : Doubleday, Page & Co., 1910. 



370 HEALTH AND THE SCHOOL 

Gives the results of introducing dancing into public schools and 
playgrounds and includes a classified list of folk dances suitable 
for various classes and occasions. 
GuLiCK AND Ayres. Medical Inspection of Schools. 244 pp. 

$1.50 (postpaid). New York: Survey Associates, Inc., 1913. 
An authoritative, comprehensive statement of the present status of 
medical inspection of schools in America. Illustrated with 
photographs, tables, diagrams, and forms. 
Hall, G. Stanley. Educational Problems. Vols. I and II. 1424 

pp. $7.50. New York: D. Appleton & Co., igii. 
Throws light on many questions which are pressing for solution 
in American elementary schools ; contains the wide array of facts 
and opinions developed in Dr. Hall's Pedagogical Seminary dur- 
ing the past 25 years. 
Hart, Hastings H. Cottage and Congregate Institutions for 

Dependent and Delinquent Children. 136 pp. Paper 50 

cents; cloth $1.00. New York: Charities Publication Com- 
mittee, 1910. 
A guide for trustees and officers of children's institutions in 
building and organizing children's homes. Illustrated. 

Preventive Treatment of Neglected Children. 419 pp. 

$2.50. New York : Charities Publication Committee, 1910. 
Contains studies of children's institutions, child helping societies, 
family home care, the placing out system, the juvenile court, and 
miscellaneous preventive agencies. 
HoAG, Ernest Bryant. The Health Index of Children. 188 pp. 

80 cents. San Francisco : Whitaker & Ray Wiggin Co., 

1910. 
A practical hand-book for school officials and teachers who are 
trying to develop a program of health supervision in schools. 
Illustrated. 
Hogan, Louise E. Children's Diet in Home and School. 194 pp. 

75 cents. New York: Doubleday, Page & Co., 1910. 
A practical guide for the feeding of children from infancy to 
the age of twelve ; containing detailed directions for selecting, 
preparing, and serving food in home and school. 
Hogarth, A. H. Medical Inspection of Schools. 360 pp. $2.00. 

Oxford : University Press, 1909. 
A broad discussion of the history and meaning of health super- 
vision in schools, including a concrete program for carrying on 
such work. 



SUMMARY OF SUGGESTED READING 371 

Holmes, Arthur H. Conservation of the Child. 345 pp. $1.25. 

Philadelphia : J. B. Lippincott Co., 1912. 
"A manual of clinical psychology presenting the examination and 
treatment of backward children." 

Jordan, David Stai^r. The Human Harvest. 122 pp. $1.07 (post- 
paid). Boston: American Unitarian Association, 1907. 
"A study of the decay of races through the survival of the 
unfit." 
Kelnyack, T. N. Medical Examination of Schools and Scholars. 

434 pp. $2.50. London : P. S. King & Son, 1910. 
A study of medical inspection as practiced in England, with 
suggestions for extending health supervision into public and 
private secondary schools, industrial schools, and orphan- 
ages. 
Oppenheim, Nathan, M. D. Care of the Child in Health. 

308 pp. $1.25. New York : The Macmillan Company, 1900. 
A practical program of child hygiene from infancy through 
childhood, formulated by a children's specialist. 

The Development of the Child. 296 pp. $1.25. New 

York : The Macmillan Company, 1898. 
An important contribution to child study. 
Perry, Clarence Arthur. Wider Use of the School Plant. 

350 pp. $1.25 (postpaid). New York: Charities Publication 

Committee, 1910. 
A detailed description of the use of school buildings for such 
activities as vacation schools,' public lectures, social centers, and 
evening schools. Questions of administration, cost, and organi- 
zation fully treated. Illustrated. 
Porter, Charles, M. D. School Hygiene and The Laivs of 

Health. 313 pp. $1.50. New York : Longmans, Green & Co., 

1906. 
A good reference book on the physiology and pathology of 
children as well as on school hygiene and sanitation. Illus- 
trated. 
Reeder, Rudolph R. Hozv Tzvo Hundred Children Live and 

Learn. 247 pp. $125. New York : Charities Publication 

Committee, 1910. 
A description of living conditions in a model orphanage, written 
by the superintendent. Illustrated. 
Saleeby, C. W. Parenthood and Race Culture. 389 pp. $2.50. 

New York: Moffat, Yard & Co., 1909. 



372 HEALTH AND THE SCHOOL 

Presents plainly the problems of race development and em- 
phasizes the need of motherhood as the most important of all 
professions. 
ScuDDER, Myron. Recreation for Rural Communities. Yonkers : 

World Book Co. (in press). 
A practical handbook for conducting recreational activities in 
the country. 

Seager, Henry R. Social Insurance: A Program of Social Re- 
form. 175 pp. $1.00. New York: The Macmillan Company, 
1910. 
Advocates clearly the general principle that certain of our most 
pressing social problems — among them health — can be adequately 
met only by the state taking direct positive action. 
Search, Preston W. The Ideal School or Looking Backward. 

375 PP- $i.20. New York: D. Appleton & Co., 1908. 
A study of possible school conditions — pedagogical, sanitary, 
hygienic — which would make for the most complete and har- 
monious development of children. 
Shaw, Edward R. School Hygiene. 260 pp. $1.00. New York: 

The Macmillan Company, 1910. 
Gives clear and thorough directions for securing good sanitation 
in school buildings and hygienic conditions for school children. 
Illustrated. 

Smedley, Emma. Institution Recipes for Use in Schools, Col- 
leges, Hospitals and Other Institutions. 280 pp. $1.35 post- 
paid. Media, Pa. : The Author. 
Taylor, F. W. The Principles of Scientific Management. 144 pp. 

$1.50. New York: Harper & Brothers, 1911. 
A discussion of the theory of scientific management sufficiently 
general to admit of application in a wide variety of cases. 
Terman, Lewis M. The Teacher's Health. 137 pp. Boston: 

Houghton-Mifflin Co., 1913. 
Discusses mortality and morbidity rate ; gives health suggestions, 
and indicates the responsibility of normal schools. 
Warbasse, J. P. Medical Sociology — The Relations of Medicine 
to Society. 355 pp. $2.00. New York: D. Appleton & Co., 
1909. 
The special aim of medical science stated to be the study of the 
prevention of conditions which destroy health and the furnishing 
of authoritative information which will place prevention largely 
in the hands of the public. 



SUMMARY OF SUGGESTED READING 373 

WiTMER, LiGHTNER. Tkc Special Class for Backivard Children. 
27s PP- $^.50. Philadelphia: Psychological Clinic Press, 191 1. 
An account of eighteen backward children who were taught in a 
special class for six weeks at the psychological laboratory and 
clinic of the University of Pennsylvania. Illustrated. 

ARTICLES, BULLETINS AND REPORTS 

Articles and Reprints 

Economic Aspect of Lengthening Human Life. Irving Fisher. 

18 pp. New Haven, 1909. The Author. 
A plea, urged from the standpoint of econom}^ for insurance 
companies to spend a small percentage of their incomes to edu- 
cate the public as well as legislators to conserve and prolong 
human life. 

Cyclopedia of Education. New York. The Macmillan Com- 
pany, 1911. Vol. II, pp. 627-630. Food and Feeding of Chil- 
dren. W. H. Burnham. 
Harper's Monthly. April, 1912. The New Meaning of^ Public 

Health. Robert Bruere. 
Traces recent enlargement of government responsibility and ex- 
penditure with respect to public health, and indicates lines for 
further action. 

Journal of Home Economics. December, 1912. Report of the 
New York School Lunch Committee. Mabel E. Kittredge. 
Popular Science Monthly. March, 1912. Professional Train- 
ing for Child Hygiene. Lewis M. Terman. 
Includes an analysis of the requirements involved for successful 
public supervision of children's health, statements of unsolved 
problems, and constructive suggestions. 
Teachers College Bulletin. Education Series A. No. 4. 10 

cents. Hints on Clothing. Mary Schenck Woolman. 
Teachers College Record. May 1912. 30 cents. Health Instruc- 
tion in the Elementary School. T. D. Wood, M. D., et al. 
States principles relating to health instruction and describes con- 
cretely typical methods and materials which have been developed 
for all the grades through the application of these principles. 
The American Magazine. March-May, 191 1. The Gospel of 
Efficiency — The Principles of Scientific Management. F. W. 
Taylor. 



374 HEALTH AND THE SCHOOL 

The Outlook. December 7, 1912. The Problem of National 

Health. Earl Mayo. 
A constructive statistical study of the annual loss in wealth and 
human lives due to preventable disease. 

The Psychological Clinic. April 15, 1912. 20 cents. Sym- 
posium on School Feeding. 
Contains articles on The School Feeding Movement, Adminis- 
tration of School Luncheons, The Training of the School Dieti- 
tian, Effects of Coffee Drinking Upon Children. 
The Survey. New York. $2.00 a year. 

A weekly journal which furnishes a basis of facts for intelli- 
gent and permanent social betterment in home, school, industry, 
and government. 

Government Publications 

Kansas State Board of Health, Topeka. Kansas Health 

Almanac, 1912. 
Minnesota State Board of Health. An Outline for the Health 

Grading of the School Child. 1912. 
National Conservation Commission. Report on National Vi- 
tality — Its Wastes and Conservation. Irving Fisher, 138 pp, 
15 cents (postpaid). Washington: Government printing of- 
fice, 1909. 
A strong presentation of the possibilities of human life and the 
opportunity for its development and prolongation through sani- 
tation, hygiene, and the awakening of the social conscience. The 
book is especially designed for students. 

United States Bureau of Education, Washington. (Available 
for free distribution.) American School Houses. Fletcher 
B. Dresslar. 133 pp. (Bulletin, 1910, No. 5.) 
A study of modern school architecture with special reference 
to sanitation. Illustrated with photographs and plans. 

Bibliography of Child Study, 1910-xi (Bulletin, 1912, 
No. 26). 

Bibliography of Exceptional Children and Their Educa- 
tion (Bulletin, 1912, No. 32). 

Cultivating School Grounds in Wake County, N. C. 
Zebulon Judd. (Bulletin, 1912, No. 28.) 

Current Educational Topics (Bulletin, 1912, No. 24). 
Contains discussions on The Duty of the State in the Medical 



SUMMARY OF SUGGESTED READING 375 

Inspection of Schools, Health Problems in Education, Sani- 
tation in Rural Communities. 

Provision for Exceptional Children in Public Schools. 
Lightner Witmer and Leonard P. Ayres, 92 pp. (Bulletin, 
1911, No. 14). 

Report of the Committee on Uniform Records and 
Reports (Bulletin, 1912, No. 23). 

Adopted by the Department of Superintendence of the Na- 
tional Education Association. 

Rural Schoolhoiises. Fletcher B. Dresslar (in prepara- 
tion). 

The Daily Meals of School Children. Caroline L. Hunt. 
(Bulletin, 1909, No. 3.) 

The Reorganized School Playground. Henry S. Curtis, 
23 pp. (Bulletin, 191 1, No. 16). 

A practical handbook for the preparation and equipment of 
modern playgrounds. 

The Status of Rural Education in the United States. 
A. C. Monohan, y^ pp. (Bulletin, 1913, No. 8). 
Virginia State Health Board, Richmond. Virginia Health 
Almanac, 1911-12. 



Publications of Societies and Other Organizations 

American Academy of Political and Social Science, Phila- 
delphia. Annals, March, 1910. $1.00. Public Recreation 
Facilities. 266 pp. 

Describes typical parks — national, state, county and city — also 
discusses the social significance of parks and playgrounds. 

Annals, March, 191 1. Paper $1.00; cloth $1.50. The 
Public Health Movement. 298 pp. 

Presents many current phases of the public health move- 
ment such as Clean Milk and Public Health, The Rural 
Health Movement, Prevention of Infantile Blindness. 

American Academy of Medicine. Proceedings of a Conference, 
April, 1912. $5.00. Secretary of the American Academy of 
Medicine, Easton, Pa. Conservation of School Children. 
293 pp. 

Contains discussions of many urgent questions relating to the 

health of school children such as The Teacher's Relation to 



376 HEALTH AND THE SCHOOL 

Health Supervision in Schools, Child Labor versus the Con- 
servation of School Children, How Should Hygiene Be Taught? 
Education for Better Parenthood. 

American School Hygiene Association. Proceedings of the 
First Six Congresses in 4 volumes. $1.08 a volume (post- 
paid). Secretary's Office, College of the City of New York. 

Volume I. (First three congresses). The Problems of Hygiene 
and the Province of the Normal School. 
H. H. Seerly, President, Iowa State Normal 
School. 
The Requirements of Proper School Furniture. 
Robert W. Lovett, M. D., Harvard Uni- 
versity Medical School. 

Volume II. (Fourth congress). Experiences in Indiana in Try- 
ing to Secure Hygienic School Houses. John 
N. Hurty, M. D., Secretary, Indiana State 
Board of Health. 

(a) New Principles in the Teaching of Hygiene. 

(b) The Teaching of Sex Hygiene. C. Ward 
Crampton, M. D., Director of Physical Train- 
ing, New York City Public Schools. 

Shall Organised Play Be Made a Regular Part 
of the Public School Curriculum? G. W. A. 
Lucky, Professor of Education, University of 
Nebraska. 

The Educative Value of the Child's Recreative 
Life and Systematic Provision for It. George 
W. Ehler, Public Schools' Athletic League, 
Baltimore. 

The Principles Underlying Modern Physical Edu- 
cation. Herman H. Home, Professor of the 
History of Education, New York University. 

The Right Standards of School Hygiene and the 
Hindrances to Meeting Them. H. H. Seerly, 
President, Iowa State Teachers' College. 

Volume III. (Fifth congress). An Inquiry Into the Problem of 
Desks for School Children. William A. 
Stecher, Director of Physical Education, Pub- 
lic Schools, Philadelphia. 



SUMMARY OF SUGGESTED READING 377 

Proper Sanitation of the Schoolroom. Ljanan A. 
Best, Principal Grammar School No. 108, 
Brooklyn, N. Y. 

Scluool Inspection in Small Towns, Arthur T. 
Cabot, M. D., Boston, Mass. 

Some Suggestions for a Course of Study in Hy- 
giene. L. N. Hines, Superintendent of 
Schools, Crawfordsville, Ind. 

The Consecration of the Affections (Often Mis- 
named Sex Hygiene). Richard C. Cabot, As- 
sistant Professor of Clinical Medicine, Har- 
vard University. 

Volume IV. (Sixth congress). Contagious Slcin Diseases in Re- 
lation to Schools. Charles J. White, M. D., 
Assistant Professor of Dermatology, Harvard 
University. 

Defects in the School Curriculum in Physical 
Training as Shown by the Disabilities of Col- 
lege Students. Dudley A. Sargent, M. D., 
Director Hemenway Gymnasium, Harvard 
University. 

Health Problems Encountered in Home Visits to 
School Children. Alfred E. Shipley, M. D., 
Brooklyn, N. Y. 

Report of the Committee on Heating and Ventila- 
tion. Luther H. Gulick, M. D., New York. 

School Nurse as a Link in the Chain of Preven- 
tive Medicine. Margaret E. Carley, Super- 
visor of Nurses, Department of Hygiene, Bos- 
ton Public Schools. 

Some New Problems of School Hygiene. Ernest 
Bryant Hoag, M. D., Minnesota State Board 
of Health. 

Problems of Health Supervision in the Schools of 
Massachusetts. David Snedden, Commissioner 
of Education, Massachusetts. 

BoY Scouts of America, New York. Official Handbook, 1913. 

408 pp. Paper 25 cents ; cloth 50 cents. 
"A handbook of wood-craft, scouting, and life craft." Illus- 
trated. 



378 HEALTH AND THE SCHOOL 

Bureau of Municipal Research, New York. Outside Coopera- 
tion with the Public Schools of Greater New York, 1912. 
48 pp. 25 cents. 
A study of the present and potential power of 119 public and 
private agencies whose forces can be utilized for promoting the 
welfare of school children. Illustrated. 

Bureau of Municipal Research, Philadelphia. Report of 
the Philadelphia Milk Show, 191 1. 123 pp. 50 cents (post- 
paid). 
A practical manual for conducting similar exhibitions. Illustrated. 
Camp Fire Girls, New York. The Book of the Camp Fire Girls, 

1913, 61 pp. Illustrated. 25 cents. 
Carnegie Foundation for the Advancement of Teaching, New 
York. 

Medical Education in Europe. Abraham Flexner, 1912. 
357 PP- 17 cents (postpaid). 

Medical Education in the United States and Canada. 
Abraham Flexner, 1910. 346 pp. 17 cents (postpa-d). 
Carnegie Laboratory for Experimental Evolution, Cold 

Springs, L. I. 
Series of Bulletins reporting currently the results of investigation 
carried on at the laboratory. 

Child Hygiene Association, Philadelphia. Report of the Phila^ 
delphia Baby Show, with the Proceedings of the Conference 
on Infant Hygiene, 1912. 270 pp. $1.00 (postpaid). 
This report constitutes a valuable manual for those who are ar- 
ranging hygiene exhibits and conferences. Illustrated. 
Eugenics Education Society, London, England. Proceedings of 
First International Eugenics Congress, 1912. 490 pp. $2.10. 
Problems in Eugenics. 
An extensive and important contribution to "practical" eugenics, 
viewed from many angles. 
Francis W. Parker School, Chicago. Year Book, 1912. 139 pp. 

35 cents. 
A concrete account of how interests natural to childhood were 
made the motive of a year's active school work. 
Health Education League, Boston. Health Education Series. 

Price of single pamphlets, from 2 to 4 cents each. 
A series of brief and practical pamphlets on health topics, such 
as Healthful Homes, The Care of Little Children, The Obser- 
vance of Health Day in Schools, Habits of Health. 



SUMMARY OF SUGGESTED READING 379 

Home and School League, Philadelphia. Annual Reports of the 
School Lunch Committee, 191 1, 19 pp., 1912, 31 pp. 

National Education Association Journal of Proceedings and 
Addresses. (Yearly) $2.00. Secretary's Office, Winona, Minn. 

1911. (a) Health and Ventilation, (b) Open Air Schools. 
Leonard P. Ayres, Associate Director, Department of Child 
Hygiene, Russell Sage Foundation. The Health of the Child 
the Joint Concern of Parent and Teacher. W. A. Evans, 
M. D., Professor of Preventive Medicine, Northwestern Uni- 
versity, formerly Health Commissioner of Chicago. The In- 
fluence of Open-air and Low-temperature School Rooms on 
the Mental Alertness and Scholarship of Pupils. Frank G. 
Bruner, Assistant Director, Department of Child Study and 
Educational Research, Public Schools, Chicago. 

1912. The Problems of Child Hygiene and the Contribution of 
Hygiene to Education. William H. Burnham, Professor of 
Pedagogy and School Hygiene, Clark University. 

The Hygiene of Rural Schools. Fletcher B. Dresslar, Special- 
ist in School Hygiene, United States Bureau of Education. 

National Society for the Study of Education. (Year books 
published by the University of Chicago Press. 75 cents each 
part.) 
Eighth year book, part 2, 1909, Education mith Reference to 
Sex: Agencies and Methods. 90 pp. C. R. Henderson, 
Professor of Sociology, University of Chicago. 
Ninth Year Book, parts i and 2, 1910, Health and Education, 
112 pp., and School Nurses, 76 pp. Thomas D. Wood, Pro- 
fessor of Physical Education, Teachers' College, et al. 

Playground and Recreation Association of America. 

I Madison Square, Nevi^ York. The Playground. $2.00 a 
year. A monthly journal, the organ of the Association, in- 
dispensable for one who would follow the recreation move- 
ment, or bear an efifective part in ft. (Index for first five 
volumes in the March number, 1912; index for sixth volume 
in March number, 1913. 

Public Education Association of the City of New York. 

Bulletin No. 9, 1913. Shall the Schools Serve Lunches? 
6 pp. A report of work done in the New York Schools by 
the School Lunch Committee, with recommendations for an 
expanded program under the Board of Education. 



38o HEALTH AND THE SCHOOL 

Russell Sage Foundation^ New York. Pamphlets. 

A Comparative Study of Public School Systems in the Forty- 
eight States, 1912. 32 pp. 15 cents. 
. "Fifteen tests of educational efficiency and accomplishment." 
Folk Dancing. Luther H. Gulick. 20 pp. 5 cents. Illustrated. 
A manual for teaching folk dancing in schools. 
Medical Inspection Legislation. Leonard P. Ayres. 53 pp. 
20 cents. 

"A tabular presentation of principal features of laws now in 
force in the United States; an abstract of the different laws; 
suggestions as to what a model law should include ; finally 
each law verbatim." 

Money Cost of Repetition versus Money Saving through Ac- 
celeration. Leonard P. Ayres. 11 pp. 5 cents. 
"Results of the study of the age and progress records of 
school children in twenty-nine cities, computing the money 
saved through rapid progress and that lost through slow 
progress." 

Receiving Home for Foundlings and for Mothers with their 
Babies. The New Type of Foundling Asylum. 8 pp. 5 cents. 
Gives detailed directions for building and equipment. Illus- 
trated with plans and photographs. 

Recreation Legislation. Lee F. Hamner. 68 pp. 20 cents. 
The Exploitation of Pleasure. Michael M. Davis, Jr. 61 pp. 
10 cents. 

A study of commercial recreations in New York City. 
The Measurement of Educational Processes and Products. 
Leonard P. Ayres. 9 pp. 5 cents. 

"An account of the development of the quantitative method 
in education." 

The Relation of Physical Defects to School Progress. Leon- 
ard P. Ayres. 9 pp. 5 cents. 
A statistical study based on 7,608 cases. 

The Unused Recreational Resources of the Average Com- 
munity. Clarence A. Perry. 14 pp. 5 cents. 
Suggests many ways In which communities may have or- 
ganized recreation at small cost. 



INDEX 



Absence from school, 
efficiency and, 4, 
health supervision and, 334, 

335, 
nurses' rooms in schools and, 

134-135- 

Adenoids, 
constitutional ills and, 15, 22, 

19s, 
corrective measures for, 23, 

335, 
delinquency and, 22, 
retardation and, 6, 
school children affected with, 

14, 20, 
upright position and, 2.'J2. 
Anemia, 
constitutional ills and, 23, 
corrective measures for, 24, 

40, 244, 
school children afifected with, 
14. 
Anemometer test, 30-31. 
Antiseptic washes, 276. 
Antitoxins, 320-323, 325, 347- 

348. 
Australia, orphans in, 298-299. 

Baby-Saving Show, Phila- 
delphia, 199. 

Baker, Josephine, 
on cost of health supervision 
in the schools of N. Y., 

26 38 



Baker, Josephine — (Cont'd). 
on decrease in number of 
physical defects and in- 
crease in school attendance 
in schools of N. Y., 334, 
335. 
Bathing, 268-269, 277. 
Blindness, prevention of, 349- 

350. 
Boston, Mass., 
health promotion by parent- 
teachers' associations, 78-79, 
medical inspection in, 128. 
Boy Scout movement, 256. 
Buildings, see school buildings. 
Bulletins, health, 
distributed by insurance com- 
panies, 95, 
instruction of parents by of- 
ficial, 83, 189, 360-362. 
Bureau of Municipal Research, 
New York, 
cooperation between school 

and outside agencies, 89, 
cooperation between school 

and parent, 74, 
cost of medical inspection by 
physicians and by nurses, 

152-153, 
per cent of school children 
with physical defects, 14. 

California, 
bubonic plague, in, 323, 



382 



INDEX 



Call f ornia — ( Cont'd). 
cooperative medical service 

in University of, 93, 
proposed health legislation in, 
80-82. 
Camp Fire Girls movement, 

257- 
Canton, Mass., school nurse in, 

154-155. 
Cardiac defects, 14, 26. 
Chicago, 111., 
Child Welfare Exhibit, in, 

199, 
cross-country clubs in, 256, 
elementary schools in, 61, 
playgrounds and recreation 

centers in, 250-251, 
publication of Health-grams 
in, 199. 
Child Hygiene, Division of, 
in New York, 90-91, 333-334, 
in Philadelphia, 90. 
Child Welfare Exhibits, 199. 
Children's Bureau, National, 

on infant mortality, 197. 
Cincinnati, Ohio, 
cooperation of parents to se- 
cure health in, 82, 
playgrounds in, 250-251, 
work certificates in, 82. 
Cleanliness, see Bathing, Cloth- 
ing, Dust, Sanitation, Teeth 
and Ventilation. 
Clinics, see Medical treatment. 
Clothing, 
bed, 241, i 

cleanliness of, 239-240, 
comfort and, 234, 
in institutions, 313, ; 

temperature and, 235-238. 



Connecticut, prevention of 

tuberculosis in, 327. 
Crane, Caroline Bartlett, work 

in public sanitation, 138. 
Curriculum, 
adapted to aptitude of pupil, 

59, 60-61, 6s, 141, 
adapted to physical condition 

of pupil, 61, 
examinations, 59, 
physical strain imposed by, 

58, 
prevalent arrangement of, 

56, 59, 
recreation periods included 

in, 57-58, 62, 66-67, 
study of hygiene included in, 

104-106, 
(see also. Home work and 

Hygiene). 

Dancing, 144. 

Deafness, see Hearing, defec- 
tive. 

Death rate, from preventable 
diseases, 302, 330-33I- 

Delinquency, 
cost of, 336, 
food and, 217-218, 
nose and throat defects and, 

22, 
playgrounds and, 250-251, 
sanitary conditions and, 43. 

Dentistry, free, 90, 135. 

Dentition, second, 
strain imposed by, 61. 

Desks, adjustable, 37, 50-51. 

Diet, see Food. 

Disease, prevention of, 
bodily carriage and, 270-271, 



INDEX 



383 



Disease,prevention of — ( Cont'd ) 
cleanliness and, 268-269, 274- 

278, 
clothing and, 235-236, 238, 
cost of, 317-327, 335-336, 
drinking water and, 265, 266, 

324, 325, 
elimination of waste and, 

267-269, 
exercise and, 244, 251, 
food and, 217-218, 225-227, 

264, 
health exhibits, lectures, etc. 

and, 83, 90-91, 95, 189, 197, 

199, 
in institutions, 303-308, 
inoculation and, 320-323, 325, 
insurance companies and, 94- 

97, 
respiration and, 260-262, 
rest and, 279, 
routine and, 309-311, 313 
(see also. Health Supervision, 
Hygiene, Medical inspec- 
tion. Medical treatment. 
Sanitation, and Ventila- 
tion). 
Dispensaries, see Medical treat- 
ment. 
Division of Child Hygiene, N. 
Y., 90-91, 333-334, 
Philadelphia, 90. 
Drinking cup, common, 36, 50. 
Drinking Water, 
abundance of, 230-231, 266- 

267, 
clean, 50, 265, 324, 325, 347, 
temperature of, 265. 
Druggist, not substitute for 
doctor, 29s, 296. 



Dust, 
bacteria and, 205, 213, 
dry sweeping and, 36, 
prevention of, 45, 51-53, 
removed from air used for 

ventilating, 48, 52, 
stationary desks and, 37. 

Efficiency, 

absence from school and, 4, 

food and, 217-218, 

hygienic activities and, 140- 
141, 

in health supervision, 131- 
133, 148-157, 

physical and mental, 143, 

rest periods and, 62, 63-64, 

routine and, 309, 

set schedule of work and, 61 

(see also, Disease, prevention 
of. Exercise, Health super- 
vision. Fatigue, and Ven- 
tilation). 
Elementary schools, 

adaptation of work to apti- 
tude of pupils in, 59-61, 65, 
141, 

home work in, 64-65, 

instruction in h^'giene and 
sanitation in, 104-105, 

manual work in, 59, 66-67, 

recreation periods in, 62, 66- 
67. 
England, 

Girl Guides in, 257, 

health of children in, loi, 

public medical service in, 86- 
87, 

school nurses in, 154, 

school yards in London, 44. 



384 



INDEX 



Eugenics, 

marriage restrictions in in- 
terest of, 356, 

segregation of feeble-minded 
and, 355-356, 

war and, 355. 
Evans, W. A., 

author of Health-grams, igp, 

on bad air, 204. 
Examinations, effects of, 59. 
Exercise, 

agreeable, 245, 

elimination of waste and, 
268, 

in the home, 271, 

prevention of disease by, 244, 

251, 

regular, 270, 

supervision of, 271 

(see also, Physical education 
and Play). 
Exhibits, 

instruction of parents by, 83, 
199, 362, 

Baby Saving Show, Phila- 
delphia, 199. 
Eyes, defective, 

constitutional ills and, 8, 20, 

correction of, 334, 

home work and, 64, 

hygiene, activities and, 140 
141, 

schools and, 7, 35, 56, 

school children affected with, 
14, 20, 

upright carriage and, 272 

(see also. Blindness). 

Fatigue, 

age periods and, 61, 



Fatigue — ( Cont'd) . 
appetite and, 266, 
chronic, 58-59, 
curriculum and, 56, 58, 
home life and, 68-69, 
hygienic activities and, 140- 

141, 
recreation periods and, 62, 71, 
sleep and, 69-72, 279, 
tests for, 58. 
Fire, prevention, 44-45. 
Fisher, Irving, 
on cost of tuberculosis to 

U. S., 326, 
on prevention of tuberculosis 

in Connecticut, 327, 
on method of determining the 

cost of disease, 329. 
Flat foot, see Orthopedic de- 
fects. 
Fletcherism, 263. 
Flexner, Abraham, on medical 

education, 285. 
Food, 
adulterated, 347, 
delinquency and efficiency 

and, 217-218, 
digestible, 225-227, 
drinking water and, 265-267, 
elimination of waste and, 

230-231, 
fatigue and appetite for, 266, 
hygienic (supplied by 

schools), 199-200, 217-218, 
in institutions, 310-311, 
mastication of, 263-264, 
nourishing, 219-224, 
regular consumption of, 265, 
rest after consumption of, 63, 

279, 



INDEX 



385 



Food — (Cont'd). 

variety in, 228 

(see also, Malnutrition). 
Fresh air, 

classes, 40, 

sleeping in the, 206, 208-210, 

school, 206. 

Gardens, school, 39, 314. 
Gary, Indiana, 
school program in, 66-67, 
playgrounds in, 126. 
Germany, 
clean water and a lower 
typhoid death rate in 
Munich, 324, 
competency of physicians in, 

285, 
cost of cholera epidemic in 

Hamburg, 322, 
determination in, of amount 

of rest required, 62, 
noon intermission in, 63-64, 
official notices to parents, yy. 
Glands, enlarged, 
other defects and, 27, 
retardation and, 6, 
school children affected with, 

14, 

tuberculosis and, 27. 
Grand Rapids, Mich., play- 
grounds in, 251. 
Gymnastics, recreation and, 63 
(see also, Physical educa- 
tion). 

Hand work, 
general ability and, 61, 
in elementary schools, 59, 61, 
66-67. 



"Health-grams," by ex-Com- 
missioner Evans of Chi- 
cago, 199. 
Health supervision, 

absence from school and, 
334 335- 

aim of, 130, 131-132, 331-332, 

compulsory, 80-81, 344-34S, 
346-348, 350, 

cost of, 333-334, 357, 

government control of, 97- 
102, 319, 326, 329-330, 351- 
353, 360, 

in institutions, 304, 

system of, I3i-i33i I48-I73- 
Hearing, defective, 

causes of, 26, 

school children affected with, 
14. 
Heart trouble, see Cardiac de- 
fects. 
Heating, 

diseases of respiratory organs 
and, 9, 

humidity and, 30, 

of toilet rooms, 36, 

proper, 45. 
Heredity, see Eugenics. 
High schools, 

adaptation of work to physi- 
cal condition of pupils in, 
61, 

home work in, 65-66, 

instruction in hygiene and 
sanitation in, 106, 

mental work in, 60-61, 

recreation periods in, 62. 
Hoboken, N. J., saving to com- 
munity by service of 
school nurses, 336. 



386 



INDEX 



Holyoke, Mass., playgrounds 

in, 251. 
Home, 
child's life in the, 66-68, 124- 

125, 

feeding in the, 192, 219-231, 

hygienic care in the, 191-196, 

lighting of the, 141, 

orphans placed in private, 
299-304, 

sanitary inspection of the, 
90-91, 136-138, 

supervision of children in the, 
124, 271, 279, 363, 

ventilation of the, 122, 210- 
211, 213-215 

(see also. Parents). 
Home and School League, 
experiments on dietary, 
217. 
Home work, abolition of, 64-65. 
Housing, see Home. 
Humidity, ventilation and, 32- 

33, 213-215. 
Hygiene, 

child, in the home, 192-196, 

division of child, 90-91, 

experiment in, 1 19-122, 

instruction in, 95, 104-107, 
141-142, 155, 199-200, 336, 

instruction in sex, 109-114, 
356, 

of school activities, regulation 
of, 51, 140-141, 

teachers trained in, 143, 157 

(see also, Disease, prevention 
of, Health supervision, 
Medical examination, Med- 
ical treatment, and Sanita- 
tion) . 



Illumination, see Lighting. 
Indiana, orphans' homes closed 

in, 300. 
Inoculation, 320-323, 325, 347- 

348. 
Institutions, 

dress in, 313, 

food in, 310-31 1, 

health conditions in, 302-303, 
305-309, 

necessary, 304, 

routine in, 309-312. 
Insurance companies, 

medical advice given by, 95- 
96, 

nurses provided by, 94. 

Japan, 

cost of cholera epidemic in 

1886 in, 322, 
dust avoided in buildings in, 

52, 
progressiveness of, in health 

matters, 239. 

Kansas, Health Almanac, 199, 
358-359. 

Lawrence, Mass., clean water 
and a lower typhoid death 
rate in, 324. 
Lectures, instructions of par- 
ents by, 79, 83, 114, 362. 
Lighting, 

correction of improper, 41, 
improper, 35, 
legal requirements for, 35, 
proper, 48-49. 
Los Angeles, Cal., 

Clinics conducted by, 135, 



INDEX 



387 



Los Angeles, Cal. — (Cont'd). 
philanthropic societies in, 91- 
92. 
Lunch, 

hygienic, supplied by schools, 

199-200, 217-218, 
rest after, 63, 279, 
rooms, 363, 364 
(see also. Food). 

Malnutrition, 
responsibility of schools and 

parents with respect to, 25, 

192, 19s, 244, 
school children affected with, 

14, 218. 
Massachusetts, 
mandatory medical inspection 

in, 154, 
orphans' homes closed down, 

300. 
Mastication, 
need of, 263-264, 
training children in, 116- 

117. 
Medical education, inadequacy 

of, 284-285. 
Medical examination, 
by insurance companies, 95- 

96, 
by nurses instead of by 

physicians, 152-159, 162, 
cooperation of hygiene spe- 
cialists in, 80, 
cooperation of principal in, 

78, 
for chronic defects, 132, 
for contagion, 131, 161-163, 

166, 307, 
in cities of U. S., 128, 



Medical examination — (Cont'd) 
methods of, 164-1O5, 166-169, 

175-189, 
periodic, 131, 159, 163, 166, 
teachers trained to make, iS7 
(see also, Disease, prevention 

of, and Medical treatment). 
Medical treatment, 
by insurance companies, 94- 

96, 
by municipality or state, 85- 

86, 98-99, 103, 132, 134-13S, 
by private agencies, 74, 85, 

88-91, 
cost of, 318, 
for contagious diseases, 163, 

167, 307-308, 320-323, 325, 
in England, 86, 
symptoms calling for, 295- 

296 
(see also. Disease, prevention 

of, and Medical examina- 
tion). 
Michigan, state home for or- 
phans in, 300. 
Milk, 
as food, 222, 225, 
clean, government control of, 

347, 
Show in Philadelphia, 199, 
stations, 91, 364, 
typhoid fever and clean, 324, 

325- 
Milwaukee, Wis., Recreation 

Survey Exhibit in, 254-255. 
Minnesota, 
responsible for death from 

typhoid, 325, 
state home for orphans in, 
300, 



388 



INDEX 



Minnesota — (Cont'd). 
teachers in, trained to make 
physical examination, 156- 

157- 
MortaHty, 

from preventable diseases, 

302, 330-331, 
from respiratory diseases, 

204, 
prevention of infant, 197. 
Mothers' pensions, 301. 
Murphy, John B., on the 
physician as teacher, 286- 
287. 

Nasal defects, see Adenoids. 
Nervous strain, 

age periods and, 61, 

curriculum and, 56, 

home life and, 68, 

home work and, 64, 

hygienic activities and, 140- 
141, 

rest and, 279, 
Nervous diseases, school chil- 
dren affected with, 14. 
New York City, 

child hygiene, division of, in, 

90-91, 333-334, 
Child Welfare Exhibit, 191 1, 

in, 199, 
clinics in, 135, 
cost of health supervision in 

schools of, 333-334, 
hygiene as taught in Speyer 

School in, 107, 118, 
increase in school attendance 

in, 334, 335, 
medical treatment in schools 

of, 135, 152, 



New York City — (Cont'd). 
periodic medical inspection 

in, 1 59, 
philanthjropic agencies in, 87- 

89, 
playgrounds in, 251, 
silver nitrate at birth com- 
pulsory in, 350. 
New York Orphanage, Hast- 
ings-on-Hudson, conservation 
of children's health, 303, 311, 

313. 
New York State, prevention of 

tuberculosis in, 326. 
Normal schools, 

training of teachers in hy- 
giene and sanitation by, 

143, 

training of teachers in sex 
matters by, 109. 
Nurses, 

cost of enlisting interest of 
parents by work of, 75-76, 

in schools, I34-I35, 364, 

saving to community by ser- 
vice of, 336, 

substitution of, for doctors in 
inspection work, 152-159, 
162. 

supplied by insurance com- 
panies, 94, 

teachers as, 200, 

visiting, 74, 137-138. 

Oakland, Cal., 

playgrounds in, 251, 

school nurses in, 155. 
Open Air, see Fresh Air. 
Orphans, 

boarding out of, 299-304, 



INDEX 



389 



Orphans — {Cont'd). 

in institutions, see Institu- 
tions. 
Orthopedic defects, 

corrective measures for, 24, 
flat-foot, 25, 

school children affected with, 
14, 24. 

Palates, defective, school chil- 
dren affected with, 14, 26. 
Panama, relative cost of health 
and disease as displayed 
by, 317-318. 
Parenthood, 
instruction in preparation for, 
log-iii, 363. 
Parents, 
cooperation of nurses with, 
74, 75-77, 82, 113-114, 137- 
138, 
cooperation of philanthropic 

societies with, 91, 
cooperation of teachers with, 

78, 2,2,2-22,2- 
consultation of physicians by, 

297, 
diagnosis of mild ailments by, 

294-295; 
choice of physician by, 288- 

290, 
ignorance of, 25, 192-195, 200, 
instruction of, 79, 82-83, 114, 

141-142, 189, 199-200, 363, 
mothers' pensions, 301, 
responsibility of, 25, 68, J4, 

192, 195, 201, 
Patent Medicines, 287. 
Patten, Simon, on the obliga- 
tion of society to pay for the 



prevention of disease, 329- 
330. 
Pediculosis, relation to enlarged 

glands, 27. 
Pennsylvania, 
prevention of tuberculosis in, 

326, 
smallpox epidemic of 1912 in, 
321. 
Pensions, mothers', for child 

rearing, 301. 
Petterson-Palmquist test, 32. 
Philadelphia, Pa., 
Baby Saving Show, 1912, in, 

199; 

health promotion by associa- 
tion of parents and teachers 
in, 78-79, 

Home and School League, 
experiments on dietary, 
217, 

Milk Show, 1911, in, 199, 

mortality in orphan asylum 
in, 302, 

smallpox epidemic of 1891-92 
in, 320-321. 
Philanthropic Societies, 

cooperation of, with school 
authorities, 88-91, 

in Los Angeles, 91-92. 
Philippines, vaccination and 

smallpox in the, 321, 322. 
Physical defects, 

constitutional ills and correc- 
tive measures for, 16-28, 

health supervision and, 334, 

335, 
prevalence of, in schools, 5, 

13-14, 15, 
retardation and, 5, 334, 335, 



390 



INDEX 



Physical defects — (Cont'd). 
standardization of, 163, 167 
(see also. Health supervi- 
sion). 

Physical education, 144, 145, 
efficiency and, 144, 
employment of play in, 144, 
methods of directing, 144, 

145- 
Physical examination, see Med- 
ical examination. 
Physical training, see Physical 

education. 
Physicians, 
ailments calling for attention 

of, 295-296, 
as teacherS; 200, 286-287, 
incompetent, 284-285, 
periodic examination by, 292, 
replaced by nurses in making 
medical examinations, 152- 
159, 162, 
standards for choice of, 288- 
290. 
Play, 

Boy Scout movement, 256, 
Camp Fire Girls movement, 

257, 
delinquency and, 250-251, 
necessity for, 244, 246-247, 

314. 
physical education and, 144, 
supervision during, 124-125, 

247,. 255- 
Playgrounds, 
campaigns for, 253, 
cost of, 250, 

delinquency and, 250-251, 
future, 363, 
in Gary, Ind., 126, 



Playgrounds — (Cont'd) . 

municipal support of, 251-252, 
size of, 44, 
supervised, 125, 255. 
Plumbing, see Sanitation. 
Porter, W. T., on relation be- 
tween physical and mental 
advance, 143. 
Prevention of disease, see Dis- 
ease, prevention of. 
Puberty, adjustment of school 
and home activities at, 61, 
68. 
Public Health and Marine Hos- 
pital Service, 322. 
Pulmonary disease, 
bad ventilation and, 9, 204- 

205, 207, 
school children affected with, 

14, 
tenements and, 346 
(see Tuberculosis). 

Recreation, 
gymnastics not, 63, 
noon intermission, 63-64, 71, 
provision for, in curriculum, 

62, 66-67 
(see also, Play, Playgrounds, 
and Schoolyards). 
Reeder, Rudolph R., on health 
conditions in N. Y. orphan- 
age, 303- 
Respiration, proper, 261-263. 
Rest, 63, 279-280. 
Retardation, 
relation between physical and 

mental, 143, 334, 33S, 
in school progress due to 
physical defects, 4-6, 



INDEX 



391 



Rhode Island, state school for 

orphans, 300. 
Rochester, N. Y., 

education in health matters 
in, 82, 

playgrounds in, 251. 
Routine, 

efficiency and, 309-312, 

health and, 309-311, 313. 
Russell Sage Foundation, 

investigations under, 5, 

medical supervision of school 
by city, 128, 

sanitary foundling asylums, 
302. 



Safety of school buildings, 44- 

45- 

San Antonio, Tex., medical ex- 
amination in, 128. 

San Francisco, Cal., school 
nurses in, 155. 

Sanitation, 
cleaning and, 3()-27, 213, 
common towel, 36, 50, 
cost of, in Panama, 318, 
drinking facilities, 36, 50, 

■ furnishings and, 213, 
inspection of, 170-171, 
instruction of teachers in, 

143, 
of homes, 90-91, 136-138, 
of toilet rooms, 2,6, 49, 
plumbing and, 49, 215, 
possible improvements in ex- 
isting systems of, 41-43, 
public, 138, 

study of, associated with civic 
interests, 122-123, 



Sanitation — {Cont'd). 
text books on, 105-106 
{see also. Heating, Humidity, 
Lighting, and Ventilation). 

Sanitary and Moral Prophy- 
laxis, Society of, Sex instruc- 
tion advocated by, iio-iii. 

School buildings, 
cleaning of, 36, 27, 51-53, 
drinking facilities in, 36, 50, 
heating of, 9, 30, 36, 45, 
humidity of, 32-33, 213-215, 
lighting of, 35, 41, 48-49, 
safety of, 44-45, 
sanitation of, see Sanitation, 
site for, 43, 
toilet rooms in, 36, 49, 
ventilation of, see Ventila- 
tion, 
yards in connection with, 39, 

44, 
{see also, Playgrounds). 

School gardens, see Garden 
School. 

School site, requisites for, 43. 

School yards, 
adapted for playgrounds, 39, 
space required for, 44, 
{see also. Playgrounds). 

Sex, 
hygiene, iio-iii, 356, 
instruction, 109-114, 
physical education adapted to, 

145, 
teachers trained in hygiene 

of, 157 
{see also, Puberty). 
Seybert Institution, Meadow- 
brook, Pa., prevention of 
contagious diseases, 303, 309. 



392 



INDEX 



Sites, see School site. 
Sleep', 
amount of, required, 69-71, 
out-of-doors, 206, 208-210, 
relaxation and, 279. 
Speyer School, N. Y., study of 
hygiene associated with 
civic life in classes of, 106- 
107, 118. 
Spinal Curvature, 
bodily carriage and, 270-271, 
desks and, 24-25, t,7- 
Sterilization of criminals and 

degenerates, 356. 
Supervision, 
of health, see Health super- 
vision, 
of play, see Play, 
of sanitation and hygiene in 
the home, see Health super- 
vision. 
Surgery, 
correction of deformities by, 

350, 
removal of adenoids by, 23. 
Swarthmore College, teachers' 
training in medical in- 
spection and examination, 

IS7- 
Sweeping dry, see Dust. 

Teachers, 
cooperation of, with parents, 

78, 200, 
diagnosis of mild ailments by, 

294-295, 
health of, 140, 
physicians as, 286-287, 
training of, in hygiene and 

and sanitation, 143, 



Teachers — {Cont'd). 

training of, in sex matters, 

109, 
training of, to make medical 
examinations, 157. 
Teeth, 
cleansing of, 277, 
defective, and constitutional 

ills, IS, 17, 18, 
defective, and enlarged 

glands, 27, 
defective and retardation, 6, 
defective, free dentistry for, 

90, 135, 
defective, school children af- 
fected with, 14, 19, 
protruding, 17, 22, 
strain imposed by second 
dentition, 61. 
Tenements, 

mortality and, 346. 
Texas, state architect for plan- 
ning school houses, 2i^2-2'Sz. 
Text books, on hygiene and 

sanitation, 105-106. 
Toilet rooms, 36, 49. 
Tonsils, hypertrophied, 
constitutional ills and, 22, 
corrective measures for, 23, 

334, 
delinquency and, 22, 
school children affected with, 
14, 20. 
Towel, common, 36, 50. 
Tuberculosis, 
cost of, 326, 
enlarged glands and, 27, 
marriage denied to persons 

afflicted with, 356, 
mortality from, 326, 



INDEX 



393 



Tuberculosis — (Confd). 
prevention of, 326-328, 
tenements and, 346, 
ventilation and, 204, 205. 

Vaccination, 321-323, 348. 
Ventilation, 

circulation of air and, 31-32, 

46-47, 21 1-2 12, 
cleanliness and coolness of 

air supplied by, 48, 
disease and, 9, 204, 205, 207, 
humidity and, 32-33, 213-215, 
of homes, 122, 210-211, 213- 

215, 

of toilet rooms, 36, 

possible improvements in ex- 
isting systems of, 39, 40, 

prevalent system of, 30, 

proper, 45-48 

(see also, Sanitation). 
Virginia, 

Health Almanac, published 
by, 199, 361, 

state health campaign con- 
ducted by University of, 54. 



Vision, sec Eyes. 



Washington, medical certificates 
for marriage required in, 
356. 

Washington, D. C, Interna- 
tional Congress of Hygiene, 
1912, in, 356. 

Water, see Drinking water. 

Welfare organizations, cooper- 
tion of, for efficiency, 88-92. 

Winter, sickness in, 9, 212. 

Wisconsin, 
state school for dependent 

children, 300, 
state health campaign con- 
ducted by University of, 54, 
sanitation of rural schools, 
state subsidies by, 54. 

Wood, Leonard, on financial 
saving from prevention of 
yellow fever, 322. 



Yards, see School yards. 



(1) 



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